Identifying the Need for and Availability of Evidence-Based Care for Sexually Transmitted Infections in Rural Primary Care Clinics.

BACKGROUND: Increasing rates of bacterial sexually transmitted infections (STIs) may lead to increased HIV rates, as the STI and HIV epidemics are syndemic. Centers for Disease Control and Prevention guidelines recommend including extragenital (i.e., rectal and/or pharyngeal) STI screenings for certain populations at increased risk of STIs and concurrent infections with HIV. METHODS: A descriptive study was conducted by interviewing staff members from 4 rural primary care clinics in areas of high need for STI and HIV services in South Carolina. Qualitative data about their clinical practices in 2021 were obtained. The primary outcome was to determine the awareness and availability of health care services associated with STI and HIV care in these locations. RESULTS: Clinics in target counties provided limited STI and HIV testing and treatment services, especially for populations at risk of infection, indicating the need for additional clinical training and professional development for all clinic staff. Specifically, only 1 of 4 clinics provided extragenital STI testing, and no clinics reported prescribing preexposure prophylaxis. CONCLUSIONS: Rural primary care clinics can fill important gaps in the availability of STI and HIV services with appropriate support and incentives. Findings from this study may aid in facilitating policy (state Medicaid agency) and program (state health department) decisions related to STI and HIV testing and treatment.

Childhood Sexual Abuse and Compulsive Sexual Behavior Among Men Who Have Sex with Men Newly Diagnosed with HIV.

Childhood sexual abuse (CSA) continues to be a public health challenge. The prevalence of experiencing CSA is higher among men who have sex with men (MSM) than the general population. CSA has been linked to compulsive sexual behavior (CSB) among varying populations but has not been examined among MSM who were newly diagnosed with HIV. Therefore, the aims of this study were to assess the direct association between CSA and CSB among newly diagnosed MSM living with HIV, and to identify the potential mediating roles of depressive symptoms and emotion regulation in the association between CSA and CSB. The study was a secondary data analysis using data obtained from 2012 to 2017 from two community HIV clinics in New York City (n = 202). CSA was operationalized with questions asking about sexual abuse during childhood/adolescence. CSB was measured using the 13-item Compulsive Sexual Behavior Inventory (CSBI). Depressive symptoms were measured using the 20-item Centers for Epidemiologic Studies Depression (CES-D) scale and emotion regulation was measured using a 36-item Difficulties in Emotion Regulation Scale (DERS). Path analysis was conducted to determine the mediating role of depressive symptoms and emotion regulation in the association between CSA and CSB. There was a statistically significant association between CSA and CSB (ß = 0.160; p = 0.019). There were statistically significant indirect associations between CSA, depressive symptoms, emotion regulation, and CSB (depressive symptoms ß = 0.0.071; p = 0.010; DERS: ß = 0.080; p = 0.006). Depressive symptoms were also correlated with emotion regulation (r = 0.596; p < 0.001). The relationship between CSA and CSB was significantly mediated by depressive symptoms and emotion regulation. Trauma-informed interventions addressing depressive symptoms and difficulties in emotion regulation may help to reduce CSB among MSM living with HIV.

Adverse Childhood Experiences and HIV-Related Stigma: A Quantitative Survey of Tanzanian Men, June 2019.

Experiencing adverse childhood experiences (ACEs) may impact personal opinions, attitudes, and judgments, which can further result in HIV-related stigma. HIV-related stigma consequentially may impact HIV preventive measures such as HIV testing, pre-exposure prophylaxis uptake, and condom use. The extent to which ACEs influence HIV-related stigma perception has not been well studied. Therefore, the study aimed to examine the association between ACEs and perceived and interpersonal HIV-related stigma among Tanzanian HIV-negative men. Quantitative survey data were obtained from the Tanzania STEP (Self-Testing Education and Promotion) project established in four wards: Mabibo, Manzese, Tandale, and Mwanyanamala. A total of 507 men responded to the ACEs and HIV-related stigma questionnaires. ACEs were operationalized as types of ACEs (environmental, physical/psychological, sexual abuse) and ACE score (0 (reference) vs. 1, 2, 3, ≥ 4). Perceived HIV-related stigma was analyzed both as a binary (HIV stigma vs. no HIV stigma) and a continuous variable. Unadjusted and adjusted multinomial logistic and linear regression models were used to assess the associations between ACEs and HIV-related stigma. ACE types were associated with HIV stigma (b = 0.237, 95% CI [0.122-0.352], p = < .0001). Findings of the adjusted multinomial logistic regression model show that experiencing one ACE (aOR = 1.9; p-value = 0.023), two ACEs (aOR = 1.8; p-value = 0.044), four or more ACEs (aOR = 4.1; p-value = < 0.0001) were associated with greater perceived HIV-related stigma. Moreover, experiencing environmental (aOR = 8.6; p-value = 0.005), physical/psychological (aOR = 2.5; p-value = 0.004), and sexual abuse (aOR = 3.4; p-value = < 0.0001) were associated with higher odds of HIV-related stigma. Our study findings suggest that those who experience childhood trauma are more likely to have a higher perception of HIV-related stigma. Intervention programs targeting HIV stigma should consider addressing ACEs entailing the behavioral and psychological impact of childhood trauma.

Stories of childhood sexual abuse (CSA) among older adults living with HIV (OALH) in South Carolina: a qualitative study.

Childhood sexual abuse (CSA) devastatingly impacts an individual's behavioral, psychological, and social health. Childhood, a developmental stage directly influenced by the home or school environment, leaves a life-long imprint. Compared with the general population, CSA prevalence is doubled among people living with HIV. Thus, the study aimed to explore CSA circumstances among older adults living with HIV (OALH) in South Carolina (SC). We included 24 OALH aged 50 and above who reported CSA. The data were collected at an immunology center in SC. In-depth semi-structured interviews were conducted, audio-recorded, transcribed, and analyzed using a thematic analysis approach. The iterative analytic process included a discussion of initial thoughts and key concepts, identification, and reconciliation of codes, and naming of emergent themes. Six themes emerged: known perpetrators, re-victimization, "nobody believed me", "cannot live like others", lack of CSA disclosure, and interconnections with other adverse childhood experiences (ACEs). CSA experiences and non-disclosure were found to be linked with shame, embarrassment, fear, and trust issues. Hence, trauma-focused interventions are required to resolve these issues and improve the quality of life of OALH with past trauma. Counseling or therapy programs should incorporate psychological and behavioral theoretical models to best target OALH who are CSA survivors.

Childhood sexual trauma and opioid use among older adults living with HIV.

Childhood sexual abuse (CSA) has been linked to substance use and substance use disorders in adulthood. However, there have been limited studies examining the relationship between CSA and opioid use among older adults living with HIV (OALH). Therefore, the aim of this study was to determine the association between CSA and opioid use among OALH (n = 91). Data were obtained from an HIV clinic population in South Carolina using paper-and-pen, and online questionnaires. CSA was operationalized using six questions from the Early Trauma Inventory-Self Report Form (Yes vs. No). Opioid use was self-report of the use of opioids including: heroin, fentanyl, Oxycontin, Vicodin, codeine, morphine (used vs. never used). Nested crude and multivariable logistic regression models adjusting for sociodemographic confounders were used to determine the association between CSA and opioid use. After adjusting for race, gender, age, and education, OALH who were CSA survivors were 21 times more likely to currently use opioids compared to OALH who were not exposed to CSA (adjusted OR: 21.1; 95% CI: 1.78-250.0). The association seen between CSA history and opioid use may be due to unresolved trauma among OALH. Trauma-informed interventions addressing CSA may help to reduce opioid use among OALH.

Health disparities in mortality among individuals with HIV-associated dementia in South Carolina.

HIV disproportionately affects the South compared to other regions of the US. Some people living with HIV (PLWH) may acquire HIV-associated neurocognitive disorders (HAND), of which HIV-associated dementia (HAD) is the most severe form. This study aimed to examine the disparities in mortality among individuals with HAD. Data were obtained from the South Carolina Alzheimer's Disease and Related Dementias Registry from 2010 to 2016 (HAD: n = 505; N = 164,982). Logistic regression and Cox proportional hazards models were used to determine mortality related to HIV-associated dementia and potential sociodemographic differences. Adjusted models controlled for age, gender, race, rurality, and place of diagnosis. Individuals diagnosed in a nursing facility were three times more likely to die with HAD compared to those diagnosed in the community (OR: 3.25; 95% CI: 2.08-5.08). Black populations were more likely to die with HAD compared to White populations (OR: 1.52; 95% CI: 0.953-2.42). Disparities in mortality among patients with HAD were found in place of diagnosis and by race. Future research should determine if mortality among individuals with HAD were as a result of HAD or non-HIV related decline.

Childhood sexual abuse and antiretroviral therapy adherence among older adults living with HIV: a mixed methods study.

Findings on the association between childhood sexual abuse (CSA) and antiretroviral therapy (ART) adherence have been varied, with some studies showing a relationship, or a lack thereof. However, to our knowledge, no study has examined this association among older adults living with HIV (OALH). Therefore, the purpose of this study was to examine the association between CSA and ART adherence among OALH using a mixed methods approach. This study, which involved a concurrent design, had two phases. The first phase comprised in-depth, semi-structured interviews of 24 adults aged 50 and older living with HIV in South Carolina. The second phase included data from 91 OALH. Thematic analysis and multivariable regression models, adjusting for age, gender, race, and income, were used to determine the association between CSA and ART adherence. The main theme emerging from the qualitative data was that CSA was not linked with ART adherence. However, contrastingly, quantitative analyses revealed a negative statistically significant association between CSA and ART adherence (adjusted ß: -3.35; 95% CI: -5.37, -1.34). This difference in findings could be due to the hidden impact of trauma and/or the use of different study populations. Future research should assess mediating pathways between CSA and ART adherence.

Modifiable and Non-Modifiable Risk Factors for Dementia Among Non-Hispanic White and Black Populations Aged 50-64 in the United States, 2006-2016.

BACKGROUND AND OBJECTIVES: Non-Hispanic Black populations (NHB) have a significantly higher prevalence of dementia than non-Hispanic Whites in the U.S., and the underlying risk factors may play a role in this racial disparity. We aimed to calculate risk scores for dementia among non-Hispanic White (NHW) and non-Hispanic Black populations aged 50-64 years over a period of 10 years, and to estimate potential differences of scores between NHW and NHB. RESEARCH DESIGN AND METHODS: The Health and Retirement Study from 2006 to 2016 was used to calculate the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) risk score, a validated score for predicting dementia risk. Weighted average CAIDE score, as well as CAIDE score for modifiable factors hypertension, obese, hypercholesterolemia, physical inactivity), and non-modifiable factors (age, sex, education) were calculated for adults aged 50-64 years with normal cognition for 2006-2008, 2010-2012, 2014-2016. The associations of race with CAIDE score and elevated CAIDE score were examined. RESULTS: A total of 10,871 participants were included in the analysis. The CAIDE score showed declining trends for NHB from 2006 to 2016, while NHB consistently had a higher total CAIDE score and CAIDE score for modifiable factors from 2006 to 2016, but not for non-modifiable factors. DISCUSSION AND IMPLICATIONS: NHB had a higher level of dementia risk factors than NHW among adults aged 50-64 years in the U.S. from 2006 to 2016, and the difference is attributable to modifiable risk factors, which holds promise for risk reduction of dementia.

Associations between sleep duration, sleep disturbance and cardiovascular disease biomarkers among adults in the United States.

BACKGROUND: Sleep problems are associated with abnormal cardiovascular biomarkers and an increased risk of cardiovascular diseases (CVDs). However, studies investigating associations between sleep problems and CVD biomarkers have reported conflicting findings. This study examined the associations between sleep problems and CVD biomarkers in the United States. METHODS: Data were from the National Health and Nutrition Examination Survey (NHANES) (2007-2018) and analyses were restricted to adults ≥ 20 years (n = 23,749). CVD biomarkers [C-reactive Protein (CRP), low-density lipoproteins, high-density lipoproteins (HDL), triglycerides, insulin, glycosylated hemoglobin (HbA1c), and fasting blood glucose] were categorized as abnormal or normal using standardized cut-off points. Sleep problems were assessed by sleep duration (short [≤ 6 h], long [≥ 9 h], and recommended [> 6 to < 9 h) and self-reported sleep disturbance (yes, no). Multivariable logistic regression models explored the associations between sleep duration, sleep disturbance, and CVD biomarkers adjusting for sociodemographic characteristics and lifestyle behaviors. RESULTS: The mean sleep duration was 7.1 ± 1.5 h and 25.1% of participants reported sleep disturbances. Compared to participants with the recommended sleep duration, those with short sleep duration had higher odds of abnormal levels of HDL (adjusted odds ratio [aOR] = 1.20, 95% confidence interval [CI] = 1.05-1.39), CRP (aOR = 3.08, 95% CI = 1.18-8.05), HbA1c (aOR = 1.25, 95% CI = 1.05-1.49), and insulin (aOR = 1.24, 95% CI = 1.03-1.51). Long sleep duration was associated with increased odds of abnormal CRP (aOR = 6.12, 95% CI = 2.19-17.15), HbA1c (aOR = 1.54, 95% CI = 1.09-2.17), and blood glucose levels (aOR = 1.45, 95% CI = 1.07-1.95). Sleep disturbance predicted abnormal triglyceride (aOR = 1.18, 95% CI = 1.01-1.37) and blood glucose levels (aOR = 1.24, 95% CI = 1.04-1.49). CONCLUSION: Short and long sleep durations were positively associated with abnormal CRP, HDL, HbA1c, blood glucose, and insulin levels, while sleep disturbance was associated with abnormal triglyceride and blood glucose levels. Since sleep is a modifiable factor, adopting healthy sleeping habits may create a balanced metabolism and reduce the risk of developing a CVD. Our study may provide insights into the relationship between sleep duration, sleep disturbance, and CVD risk.

Food Insufficiency, Supplemental Nutrition Assistance Program (SNAP) Status, and 9-Year Trajectory of Cognitive Function in Older Adults: The Longitudinal National Health and Aging Trends Study, 2012-2020.

BACKGROUND: Despite findings from cross-sectional studies, how food insecurity experience/Supplemental Nutrition Assistance Program (SNAP) status relates to cognitive decline over time has not been fully understood. OBJECTIVES: We aimed to investigate the longitudinal associations between food insecurity/SNAP status and cognitive function in older adults (≥65 y). METHODS: Longitudinal data from the National Health and Aging Trends Study 2012-2020 were analyzed (n = 4578, median follow-up years = 5 y). Participants reported food insecurity experience (5-item) and were classified as food sufficient (FS, no affirmative answer) and food insufficient (FI, any affirmative answer). The SNAP status was defined as SNAP participants, SNAP eligible nonparticipants (≤200% Federal Poverty Line, FPL), and SNAP ineligible nonparticipants (>200% FPL). Cognitive function was measured via validated tests in 3 domains, and the standardized domain-specific and combined cognitive function z-scores were calculated. Mixed-effect models with a random intercept were used to study how FI or SNAP status was associated with combined and domain-specific cognitive z-scores over time, adjusting for static and time-varying covariates. RESULTS: At baseline, 96.3% of the participants were FS and 3.7% were FI. In a subsample (n = 2832), 10.8% were SNAP participants, 30.7% were SNAP eligible nonparticipants, and 58.6% were SNAP ineligible nonparticipants. Compared with the FS group in the adjusted model (FI vs. FS), FI was associated with faster decline in the combined cognitive function scores [-0.043 (-0.055, -0.032) vs. -0.033 (-0.035, -0.031) z-scores per year, P-interaction = 0.064]. Cognitive decline rates (z-scores per year) in the combined score were similar in SNAP participants (ß = -0.030; 95% CI: -0.038, -0.022) and SNAP ineligible nonparticipants (ß = -0.028; 95% CI: -0.032, -0.024), both of which were slower than the rate in SNAP eligible nonparticipants (ß = -0.043; 95% CI: -0.048, -0.038; P-interaction < 0.0001). CONCLUSIONS: Food sufficiency and SNAP participation may be protective factors preventing accelerated cognitive decline in older adults.

Social Support, Internalized HIV Stigma, Resilience and Depression Among People Living with HIV: A Moderated Mediation Analysis.

Internalized HIV stigma has been associated with depression among people living with HIV (PLWH). However, it is still unclear whether resilience would mediate the association between internalized HIV stigma and depression and how this indirect effect would be moderated by social support. Data were collected from 402 PLWH in South Carolina using a cross-sectional survey. Data were fitted using a path model that specified the extent to which internalized HIV stigma and depression were related through resilience and how this effect was moderated by social support. Sociodemographic characteristics were included in the model as covariates. The indirect effect of internalized HIV stigma on depression through resilience was statistically significant for high social support but not for low social support. To mitigate negative impacts of internalized HIV stigma on mental health of PLWH, intervention efforts should integrate multilevel components for promoting both resilience and social support.

Psychosocial Protective and Risk Factors of Quality of Life Outcomes Among Older Adults Living With HIV.

HIV continues to be a public health issue for older adults. Previous studies have examined predictors of quality of life (QoL) among people living with HIV (PLWH), but the majority have been in international settings and have not focused on older adults living with HIV (OALH). The aim of this study was to examine the associations between psychosocial protective and risk factors (resilience, internalized HIV-related stigma, and depression), and overall and domains (physical, psychological, independence, social, environmental, and spiritual) of QoL among OALH. Data were obtained from 156 OALH living in South Carolina. Resilience was positively associated with all QoL domains except the spiritual domain. Internalized HIV-related stigma was associated with all QoL domains except the psychological and environmental domains. Depression was associated with the overall QoL measure and all domains. Interventions aimed at increasing resilience, attenuating internalized HIV-related stigma and depressive symptoms may be warranted for OALH, which may improve overall and varying domains of QoL.

Coping and ART adherence self-efficacy among people living with HIV in South Carolina.

In the US, more than 50% of new HIV infections are reported in southern states. Besides, the incidence rate of HIV in South Carolina is 17 per 100,000 population. Regardless of improved quality of life with the advent of ART, coping with stressors may influence ART adherence self-efficacy. This study assessed the association between coping strategies and ART adherence self-efficacy among people living with HIV (PLWH) in South Carolina. Cross-sectional data were obtained from 402 PLWH attending a large immunology center in South Carolina in 2018. Unadjusted and adjusted linear regression models were used to determine the association between coping strategies and ART adherence self-efficacy. Alcohol or drug use was negatively associated with ART adherence self-efficacy (b = -0.170, 95% CI [-0.255, -0.085], p = 0.0001). Religiosity was positively associated with ART adherence self-efficacy (b = 0.101, 95% CI [0.017, 0.185], p = 0.019). Overall coping and self-motivation were not significantly associated with ART adherence self-efficacy. Accentuating religiosity and attenuating alcohol or drug use as a means of coping may improve ART adherence self-efficacy among PLWH.

Association between sociodemographic characteristics and HIV disclosure among people living with HIV in South Carolina: a structural equation modeling approach.

HIV disclosure continues to be a key consideration among people living with HIV (PLWH). However, there is a lack of studies assessing factors associated with HIV disclosure among PLWH in the Southern U.S. Therefore, the aim of this study was to assess the association between sociodemographic risk factors and HIV disclosure using a structural equation modeling approach among PLWH in South Carolina. Exploratory factor analysis was used to operationalize HIV disclosure. Structural equation models were used to determine the associations between sociodemographic factors and HIV disclosure among PLWH. Two latent variables were obtained for HIV disclosure: partners (stable partners, spouses, casual partners), and family/friends (parents, grandparents, siblings, children, adult children, friends, and coworkers). After adjusting for confounders, Black populations were less likely to disclose their HIV status to both partners (ß = -0.250, p = 0.006) and family/friends (ß = -0.246, p < 0.001) compared to non-Black populations. As yearly income increased, the likelihood of HIV disclosure to family/friends decreased (ß = -0.300, p = <0.001). As time since diagnosis increased, the likelihood of HIV disclosure to family/friends increased (ß = 0.266, p = 0.001). Future research can assess the feasibility of implementing disclosure interventions that are geared towards Black, high income and newly diagnosed PLWH and the associations of psychosocial factors and HIV disclosure.

Gender and coping with HIV: a qualitative study of older childhood sexual abuse survivors living with HIV.

People living with HIV often have complex identities and histories. Understanding how these experiences influence adherence to treatment and quality of life are critical to the HIV care. The experiences of older adults living with HIV are uniquely embedded within biology and aging as well as gender. This study described the gendered strategies for coping with HIV among older adults who are childhood sexual abuse survivors. Audio-recorded semi-structured interviews were performed with 24 adults who are 50 years and older from a clinic in South Carolina. Thematic analysis approach was used to discuss key concepts, reconcile codes, and name emergent themes. Overall, the participants used a spectrum of coping strategies including spirituality, seclusion, social support, substance use, engagement in HIV care, information acquisition and sharing, and cognitive reframing. Our findings suggest the potential for growth and recovery is heightened if the interplay of HIV diagnosis, aging, coping, and mental health is considered. Healthcare providers should assess the ways in which individuals interpret their HIV diagnosis and other lived experiences to better understand their patients' mental health. Knowledge of gender-based coping strategies used in HIV-relevant outcomes can be translated into more effective treatment plans to improve the overall quality of life.

"Is it worth living?" psychosocial challenges of childhood sexual abuse survivors aging with HIV.

Older adults living with HIV (OALH) undergo challenges such as comorbidities, social isolation, and "double stigma" associated with their HIV and aging statuses. Simultaneously, research has shown that experiences of childhood sexual abuse (CSA) continue to impact the quality of life across the lifespan and may pose unique hardships for older adults. Despite the high prevalence of trauma among people living with HIV, research examining the psychosocial challenges of OALH with a CSA history is scant. To address this gap in the literature, this study aimed to explore psychosocial challenges among OALH who are CSA survivors using a qualitative approach. Twenty-four in-depth, semi-structured interviews were completed with OALH (age 50 years and older) who reported histories of CSA. Multiple coders and an inductive coding process were employed for data analysis. Four main themes regarding psychosocial challenges emerged from the analysis: (1) depression and suicidal ideation, (2) fear and anxiety, (3) social support issues, and (4) memory issues. The authors discuss the implications of these findings and the importance of trauma-informed treatment for these individuals.

Associations between HIV disclosure and HIV care continuum outcomes among men who have sex with men living with HIV: systematic review and meta-analysis.

ABSTRACTThe objective of this study is to synthesize the existing empirical literature and perform a systematic review and meta-analysis on the relationship between HIV disclosure and engagement in the HIV care continuum among men who have sex with men living with HIV. Twenty-three studies were included, with thirteen quantitative studies and ten qualitative studies. Meta-analytic techniques were used to compute and aggregate effect sizes (odds ratio [OR] and their confidence intervals [95%CI]) for the quantitative studies and a thematic analysis was employed for qualitative studies. Given the small number of eligible studies, meta-analysis was only conducted for the linkage to care outcome, where a positive association was observed from the pooled estimation (OR = 1.51, 95%CI [1.15, 1.99]). Regarding ART initiation, retention in care, and viral suppression outcomes, most of the individual studies revealed a positive association between HIV disclosure and these outcomes. Thematic analysis from qualitative studies complemented the quantitative findings by incorporating the approaching and avoidance motivations underlying the relationship between non-HIV disclosure and the participation in HIV care continuum. The small number of available studies limits the definitive conclusions, and more research is needed to ascertain the magnitude of effect sizes.

The mediating role of social support between HIV stigma and sexual orientation-based medical mistrust among newly HIV-diagnosed gay, bisexual, and other men who have sex with men.

HIV-related stigma and medical mistrust are significant challenges to addressing HIV inequities among gay, bisexual, and other men who have sex with men (MSM). HIV-related stigma is associated with high levels of medical mistrust, but there is limited knowledge regarding the mechanisms that link these variables. We examined the potential mediating roles of social support and coping in the relationship between perceived HIV stigma and sexual orientation based-medical mistrust among newly HIV-diagnosed MSM. We hypothesized that HIV-related stigma would be associated with mistrust and that social support, and coping would mediate this relationship. Data were obtained from 202 newly HIV-diagnosed (<1 year) MSM receiving care at community HIV clinics in New York. A path model indicated that HIV stigma was directly related to greater sexual orientation based medical mistrust, and that this relationship was mediated by social support. However, coping did not mediate the relationship between HIV stigma and mistrust. Efforts to increase social support and decrease stigma are critical for strengthening relationships between MSM and HIV care networks. Future research should assess the feasibility of designing and implementing interventions focused on increasing social network support and improving trust in the medical community among newly HIV-diagnosed MSM.

Gendered racism, anxiety, and depression: the mediating roles of gendered racialized stress and social isolation.

OBJECTIVE: Black women experience unique stressors linked to the intersection of racism and sexism (i.e. gendered racism). While the negative effects of gendered racism are associated with Black women's health, less is known about factors that describe these relationships. DESIGN: Using data from 263 Black women, we used path analysis to examine direct and indirect effects of gendered racism on anxiety and depression through gendered racialized stress. We also examined the direct and indirect effects of gendered racialized stress on anxiety and depression through social isolation. RESULTS: After adjusting for covariates, gendered racism, and gendered racialized stress were not statistically significant predictors of anxiety and depression. However, gendered racism was a statistically significant predictor of gendered racialized stress. Also, social isolation mediated the relationships between gendered racism, gendered racialized stress, and anxiety, as well as depression. CONCLUSIONS: Stress from gendered racism is associated with loneliness, which can negatively impact Black women's mental health. Findings suggest that gendered racialized stress and social isolation is important for understanding the relationship between gendered racism and mental health outcomes, such as anxiety and depression.

Racial, Ethnic, and Rural/Urban Disparities in HIV and Sexually Transmitted Infections in South Carolina.

Examining the current incidence rates of HIV and STIs among racial and ethnic minority and rural residents is crucial to inform and expand initiatives and outreach efforts to address disparities and minimize the health impact of these diseases. A retrospective, cross-sectional study was conducted using Medicaid administrative claims data over a 2-year period (July 2019-June 2021) in South Carolina. Our main outcomes of interest were claims for chlamydia, gonorrhea, syphilis, and HIV. Any beneficiary with at least one claim for a relevant diagnosis throughout the study period was considered to have one of these diseases. Descriptive analyses and multivariable regression models were used to estimate the association between STIs, HIV, race and ethnicity, and rurality. Overall, 158,731 Medicaid beneficiaries had at least one medical claim during the study period. Most were female (86.6%), resided in urban areas (66.6%), and were of non-Hispanic Black race/ethnicity (42.6%). In total, 6.3% of beneficiaries had at least one encounter for chlamydia, 3.2% for gonorrhea, 0.5% for syphilis, and 0.8% for HIV. In multivariable models, chlamydia, gonorrhea, and HIV claims were significantly associated with non-Hispanic Black or other minority race/ethnicity compared to non-Hispanic white race/ethnicity. Rural residents were more likely to have a claim associated with chlamydia and gonorrhea compared to urban residents. The opposite was observed for syphilis and HIV. Providing updated evidence on disparities in STIs and HIV among racial/ethnic minority and rural populations in a southern state is essential for shaping state Medicaid policies to address health disparities.