A necessary conversation to develop chatbots for HIV studies: qualitative findings from research staff, community advisory board members, and study participants.

Chatbots increase business productivity by handling customer conversations instead of human agents. Similar rationale applies to use chatbots in the healthcare sector, especially for health coaches who converse with clients. Chatbots are nascent in healthcare. Study findings have been mixed in terms of engagement and their impact on outcomes. Questions remain as to chatbot acceptability with coaches and other providers; studies have focused on clients.To clarify perceived benefits of chatbots in HIV interventions we conducted virtual focus groups with 13 research staff, eight community advisory board members, and seven young adults who were HIV intervention trial participants (clients). Our HIV healthcare context is important. Clients represent a promising age demographic for chatbot uptake. They are a marginalized population warranting consideration to avoid technology that limits healthcare access.Focus group participants expressed the value of chatbots for HIV research staff and clients. Staff discussed how chatbot functions, such as automated appointment scheduling and service referrals, could reduce workloads while clients discussed the after-hours convenience of these functions. Participants also emphasized that chatbots should provide relatable conversation, reliable functionality, and would not be appropriate for all clients. Our findings underscore the need to further examine appropriate chatbot functionality in HIV interventions.

Using Machine Learning to Identify Predictors of Sexually Transmitted Infections Over Time Among Young People Living With or at Risk for HIV Who Participated in ATN Protocols 147, 148, and 149.

BACKGROUND: Sexually transmitted infections (STIs) among youth aged 12 to 24 years have doubled in the last 13 years, accounting for 50% of STIs nationally. We need to identify predictors of STI among youth in urban HIV epicenters. METHODS: Sexual and gender minority (gay, bisexual, transgender, gender-diverse) and other youth with multiple life stressors (homelessness, incarceration, substance use, mental health disorders) were recruited from 13 sites in Los Angeles and New Orleans (N = 1482). Self-reports and rapid diagnostic tests for STI, HIV, and drug use were conducted at 4-month intervals for up to 24 months. Machine learning was used to identify predictors of time until new STI (including a new HIV diagnosis). RESULTS: At recruitment, 23.9% of youth had a current or past STI. Over 24 months, 19.3% tested positive for a new STI. Heterosexual males had the lowest STI rate (12%); African American youth were 23% more likely to acquire an STI compared with peers of other ethnicities. Time to STI was best predicted by attending group sex venues or parties, moderate but not high dating app use, and past STI and HIV seropositive status. CONCLUSIONS: Sexually transmitted infections are concentrated among a subset of young people at highest risk. The best predictors of youth's risk are their sexual environments and networks. Machine learning will allow the next generation of research on predictive patterns of risk to be more robust.

Chatbots for HIV Prevention and Care: a Narrative Review.

PURPOSE OF REVIEW: To explore the intersection of chatbots and HIV prevention and care. Current applications of chatbots in HIV services, the challenges faced, recent advancements, and future research directions are presented and discussed. RECENT FINDINGS: Chatbots facilitate sensitive discussions about HIV thereby promoting prevention and care strategies. Trustworthiness and accuracy of information were identified as primary factors influencing user engagement with chatbots. Additionally, the integration of AI-driven models that process and generate human-like text into chatbots poses both breakthroughs and challenges in terms of privacy, bias, resources, and ethical issues. Chatbots in HIV prevention and care show potential; however, significant work remains in addressing associated ethical and practical concerns. The integration of large language models into chatbots is a promising future direction for their effective deployment in HIV services. Encouraging future research, collaboration among stakeholders, and bold innovative thinking will be pivotal in harnessing the full potential of chatbot interventions.

Exercise preferences for young people at-risk for and living with HIV: a short report.

Exercise can improve physical and mental health for young people at risk for and with HIV, but prevalence rates remain low. This study explored exercise preferences and barriers among young people at risk for and with HIV, and potential gender differences. A total of 129 participants (66.7% male, mean age = 23.8 [SD = 2.1; range: 19-28], 35.7% Black/African American) at-risk for or with HIV were recruited from a larger study and completed an online survey of exercise preferences and barriers. Overall, participants preferred an exercise program that takes place at a fitness center, occurs alone, has a coach/instructor present, is between 30 and 60 minutes, lasts longer than 8 weeks, and includes aerobic and resistance exercises. The fatiguing nature of exercise and cost were common barriers among all genders. Few gender differences emerged. These results should be used to design exercise programs for young adults at risk for and with HIV.

Alcohol Misuse Among Youth Living With and at High Risk for Acquiring HIV During the COVID-19 Stay-at-Home Orders: A Study in Los Angeles and New Orleans.

BACKGROUND: To slow the spread of the COVID-19 virus, governments across the globe instituted stay-at-home orders leading to increased stress and social isolation. Not surprisingly, alcohol sales increased during this period. While most studies primarily focused on alcohol consumption among college students or adults, this study investigates alcohol misuse among marginalized youth in the USA. We examined risk factors associated with hazardous alcohol use and binge drinking including risk behaviors, life stressors and demographic characteristics. METHODS: In October 2020, youth living with or at high risk for acquiring human immunodeficiency virus (HIV), participating in community-based research to improve HIV prevention and care, were invited to complete an online survey to assess the impact of the stay-at-home orders on multiple aspects of their daily life. RESULTS: Respondents (n = 478) were on average 23 years old; cisgender (84%), not-heterosexual (86.6%), Latino or Black/African American (73%) and assigned male at birth (83%); 52% reported being employed and 14% reported living with HIV. White participants and those who use drugs had higher odds of hazardous alcohol use and binge drinking, compared with other race categories and non-drug users, respectively. CONCLUSION: Contrary to findings from adult studies, we did not observe an increase in hazardous or binge drinking among youth at risk for HIV. Hazardous alcohol use and binge drinking was more likely among White participants, those who use drugs and those who were hazardous/binge drinkers prior to the COVID-19 lockdown, which points to the importance of identifying and treating youth who misuse alcohol early to prevent future alcohol misuse.

Response Patterns to Weekly Short Message Service Health Surveys Among Diverse Youth at High Risk for Acquiring HIV.

HIV researchers use short messaging service (SMS)-based surveys to monitor health behaviors more closely than what would be possible with in-person assessment. Benefits are tempered by nonresponse to completing surveys. Understanding response patterns and their associated study participant characteristics would guide more tailored use of SMS-based surveys for HIV studies. We examined response to weekly 7-item SMS surveys administered as part of an HIV prevention trial. Using Mixture hidden Markov models (MHMM), we identified the underlying response patterns shared by subgroups of participants over time and quantified the association between these response patterns and participant characteristics. Three underlying response patterns were identified; responders, responders with phone-related errors, and non-responders. Non-responders versus responders were more likely to be younger, male, cis-gender, Black and Latinx participants with histories of homelessness, incarceration, and social support service utilization. Responders with phone-related errors compared to non-responders were more likely to be Black, Latinx, female, students, and have a history of incarceration and social support service utilization. More nuanced results from MHMM analyses better inform what strategies to use for increasing SMS response rates, including assisting in securing phone ownership/service for responders with phone-related errors and identifying alternative strategies for non-responders. Actively collecting and monitoring non-delivery notification data available from SMS gateway service companies offers another opportunity to identify and connect with participants when they are willing but unable to respond during follow-up.

Substance Use, Violence, and Sexual Risk Among Young Cis-Gender Women Placed at High-Risk for Human Immunodeficiency Virus Infection.

The substance use, violence, and AIDS (SAVA) syndemic framework is used to study risk for HIV/AIDS. As a secondary analysis from a large HIV/AIDS prevention study, we categorized participants into having from zero to three SAVA conditions based on the presence or absence of self-reported substance use in the past 4 months, history of lifetime sexual abuse, and intimate partner violence. We used Poisson regression models to examine the association between the number of SAVA conditions and sexual risk behavior. Among all participants (n = 195, median age, 20), 37.9%, 19.5%, and 6.7% reported occurrence of one, two, and all three SAVA conditions, respectively. We found that more than one SAVA condition experienced by women was significantly associated with having more than one sex partner (adjusted prevalence ratio [aPR] = 1.88; 95% confidence interval [CI] = 1.28, 2.76) and with substance use before sex (aPR = 1.61 95% CI = 1.06, 2.45).

Intersection of COVID-19, HIV and exercise: a commentary with home-based exercise recommendations for practice.

The worldwide spread of COVID-19 has led to closures or reduced capacity of non-essential businesses and recreational areas and stay-at-home orders to promote social distancing. Although effective to reduce transmission, these policies may negatively impact exercise behaviors. Exercise is effective at mitigating the risk of developing or exacerbating several of underlining risk factors for a more severe COVID-19 disease course and may be particularly important for people with HIV (PWH). In this commentary, we discuss the intersection of COVID-19 and exercise with a specific focus on people living with HIV. We then provide a pragmatic, home-based exercise routine that can be performed with little to no equipment or supervision. It is important for PWH (and others) to start or maintain at least some level of exercise to reduce the risk of a severe COVID-19 disease course and to improve other health outcomes in this unfamiliar climate.

Psychiatric hospitalization among youth at high risk for HIV.

Youth at-risk for HIV are also at-risk for mental health disorders and psychiatric hospitalization. Understanding the association between engagement in HIV prevention, concurrent risk behaviors, and psychiatric hospitalization may lead to improvements in integrated prevention and mental health treatment efforts. Youth at-risk for HIV, aged 14-24 years old, predominantly Black/African American and Latinx (75%) were recruited through youth-serving clinics and community sites in Los Angeles (n = 839) and New Orleans (n = 647). We compared youth with and without histories of psychiatric hospitalization on engagement in HIV prevention, concurrent risk behaviors, and demographic characteristics. We examined predictors of hospitalization using multiple imputations for missing data. Hospitalized youth (30%) were more involved in HIV programs, but were less likely to use PrEP/PEP or condoms than non-hospitalized youth. The odds of hospitalization were higher for transgender/gender nonconforming youth relative to cisgender youth; the OR was increased after adjustment for concurrent risk behaviors. Hospitalization was associated with homelessness, trauma, incarceration, substance use, and involvement in substance abuse treatment programs. There is a continuing need to integrate the diagnosis and treatment of mental health disorders into HIV prevention programs to better address multiple challenges faced by vulnerable youth.

A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial.

BACKGROUND: Female entertainment workers (FEWs) in Cambodia experience a greater prevalence of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), psychological distress, substance abuse, and gender-based violence (GBV) than the general female population. Reaching FEWs with health education and linking them to services has been difficult because of their hidden and stigmatized status. OBJECTIVE: This study evaluated the efficacy of the Mobile Link intervention in improving FEWs' health by engaging and connecting them to existing HIV, sexual and reproductive health, and GBV services. METHODS: A randomized controlled trial was conducted between March 2018 and June 2019 in the capital city and 3 other provinces in Cambodia. FEWs in the intervention arm received automated twice-weekly Short Message Service messages and voice messages with health information and direct links to outreach workers. The control group received the existing standard care, including free HIV and STI counseling and testing and a toll-free helpline staffed by trained counselors. We used a stratified random sampling method to select participants from 5 study sites in the 4 selected provinces. Initially, we randomly selected 600 participants from a list of 4000 FEWs by age group (18-24 and 25-30 years) and study site using a random number generator and enrolled them in person. The primary outcome measures included self-reported HIV and STI testing, condom use, and contraceptive use assessed through a face-to-face structured interview. We also measured secondary outcomes, including contact with outreach workers, escorted referral service use, forced drinking, and GBV experiences. Intervention effects were modeled using repeated measures, multilevel mixed-effects logistic regression. RESULTS: A total of 1118 participants were recruited and enrolled in the study. We included 218 FEWs in the intervention arm and 170 FEWs in the control arm in the per protocol analyses after removing 730 dropouts. Evidence of positive intervention effects was detected for the following secondary outcomes: contacting an outreach worker (at 30 weeks: adjusted odds ratio [AOR] 3.29, 95% CI 1.28-8.47), receiving an escorted referral (at 30 weeks: AOR 2.86, 95% CI 1.09-7.52; at 60 weeks: AOR 8.15, 95% CI 1.65-40.25), and never being forced to drink at work (at 60 weeks: AOR 3.95, 95% CI 1.62-9.60). Over time, no significant differences between intervention and control groups were observed for any primary outcomes in the fully adjusted models. CONCLUSIONS: The Mobile Link intervention effectively connected FEWs with outreach workers and escorted referrals but did not show an effect on primary outcomes. Reduced forced drinking at work was also significantly more extensive in the intervention group than in the control group. Longer-term messaging may increase access to services and impact FEWs' health outcomes in the future. TRIAL REGISTRATION: Clinicaltrials.gov NCT03117842; https://clinicaltrials.gov/ct2/show/NCT03117842. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-018-2614-7.

Optimizing Screening for Anorectal, Pharyngeal, and Urogenital Chlamydia trachomatis and Neisseria gonorrhoeae Infections in At-Risk Adolescents and Young Adults in New Orleans, Louisiana and Los Angeles, California, United States.

BACKGROUND: Public health organizations have inconsistent recommendations for screening adolescents and young adults for Chlamydia trachomatis and Neisseria gonorrhoeae infections. Guidelines suggest different combinations of anorectal, pharyngeal, and urogenital testing based on age, sex, and sexual activity. Further evaluation of how identity and behaviors impact the anatomic distribution of C. trachomatis and N. gonorrhoeae infection is needed to optimize future screening practices. METHODS: We assessed the positivity of C. trachomatis and N. gonorrhoeae infections at different anatomic sites in a cohort of at-risk sexually active adolescents and young adults aged 12-24 years in New Orleans, Louisiana and Los Angeles, California. Participants were tested for C. trachomatis and N. gonorrhoeae at 3 sites (anorectum, pharynx, and urethral/cervix) every 4 months using self-collected swabs. We stratified anatomic distributions of infection into 4 gender and sexual behavior categories: (1) cisgender men who have sex with men and transgender women (MSMTW); (2) cisgender heterosexual males; (3) cisgender heterosexual females; and (4) gender minorities assigned female at birth. RESULTS: While three-site testing detected all infections, two-site (anorectum and urethra/cervix) testing identified 92%-100% of C. trachomatis or N. gonorrhoeae infections in participants assigned female at birth and cisgender heterosexual males. For MSMTW, two-site anorectal and pharyngeal testing vs single-site anorectal testing increased the proportion of individuals with either infection from 74% to 93%. CONCLUSIONS: Sexual behavior and gender identity may influence detection of C. trachomatis and N. gonorrhoeae infections at specific anatomic testing sites. Testing guidelines should incorporate sexual behavior and gender identity. CLINICAL TRIALS REGISTRATION: NCT03134833.

A Tale of Two Cities: Exploring the Role of Race/Ethnicity and Geographic Setting on PrEP Use Among Adolescent Cisgender MSM.

Although pre-exposure prophylaxis (PrEP) could substantially reduce the risk of HIV acquisition among adolescent cisgender men who have sex with men (cisMSM), various barriers faced by people of color, particularly within the southern region of the U.S., may lead to racial disparities in the utilization of PrEP. Few studies, however, have explored racial/ethnic differences in PrEP use by geographic setting among adolescent cisMSM. We conducted a cross-sectional analysis examining racial disparities in PrEP use among cisMSM ages 15-24 years in New Orleans, Louisiana, and Los Angeles, California recruited between May, 2017 and September, 2019. The odds of PrEP use among AA adolescents were considerably lower than White adolescents in New Orleans (OR (95% CI): 0.24 (0.10, 0.53)), although we did not find evidence of differences in Los Angeles. Our findings underscore the need for targeted interventions to promote PrEP use among adolescent MSM, particularly among AA adolescent cisMSM living in the southern region of U.S.

A qualitative study of antiretroviral therapy adherence interruptions among young Latino men who have sex with men with HIV: Project D.A.I.L.Y.

Consistent antiretroviral therapy (ART) adherence is necessary for HIV viral suppression. However, adherence may fluctuate around daily routines and life events, warranting intervention support. We examined reasons for ART adherence interruptions, using in-depth, semi-structured qualitative interviews, among young (18-34-year-old) Latino men who have sex with men (YLMSM) with HIV. Interviews (n = 24) were guided by the Theory of Planned Behavior, the Information-Motivation-Behavioral Skills Theory, and the Socio-Ecological Model. Two coders independently coded transcripts using NVivo 12 software and synthesized codes into themes using Thematic Content Analysis. Results suggested 4 primary influences on ART adherence interruptions: (1) HIV diagnosis denial, (2) breaks in daily routine, (3) substance use, and (4) HIV status disclosure. Participant quotes highlighted routinization of pill-taking and planning ahead for breaks in routine as critically important. The narrative suggested modification of pill-taking routines during alcohol use, and that periods most vulnerable for long-term interruptions in ART adherence were following an HIV diagnosis and during periods of drug use. Support at the time of HIV diagnosis, including a plan for routinization of pill taking, and adaptive interventions incorporating real-time support during breaks in routines and substance use episodes may be one way to help YLMSM adhere to ARTs.

Using Machine Learning to Predict Young People's Internet Health and Social Service Information Seeking.

Machine learning creates new opportunities to design digital health interventions for youth at risk for acquiring HIV (YARH), capitalizing on YARH's health information seeking on the internet. To date, researchers have focused on descriptive analyses that associate individual factors with health-seeking behaviors, without estimating of the strength of these predictive models. We developed predictive models by applying machine learning methods (i.e., elastic net and lasso regression models) to YARH's self-reports of internet use. The YARH were aged 14-24 years old (N = 1287) from Los Angeles and New Orleans. Models were fit to three binary indicators of YARH's lifetime internet searches for general health, sexual and reproductive health (SRH), and social service information. YARH responses regarding internet health information seeking were fed into machine learning models with potential predictor variables based on findings from previous research, including sociodemographic characteristics, sexual and gender minority identity, healthcare access and engagement, sexual behavior, substance use, and mental health. About half of the YARH reported seeking general health and SRH information and 26% sought social service information. Areas under the ROC curve (≥ .75) indicated strong predictive models and results were consistent with the existing literature. For example, higher education and sexual minority identification was associated with seeking general health, SRH, and social service information. New findings also emerged. Cisgender identity versus transgender and non-binary identities was associated with lower odds of general health, SRH, and social service information seeking. Experiencing intimate partner violence was associated with higher odds of seeking general health, SRH, and social service information. Findings demonstrate the ability to develop predictive models to inform targeted health information dissemination strategies but underscore the need to better understand health disparities that can be operationalized as predictors in machine learning algorithms.

Community-based Implementation of Centers for Disease Control and Prevention's Recommended Screening for Sexually Transmitted Infections Among Youth at High Risk for HIV Infection in Los Angeles and New Orleans.

We examined whether the implementation of the Centers for Disease Control and Prevention's recommended screening of Chlamydia trachomatis/Neisseria gonorrhoeae with proactive follow-up among high-risk youth recruited from community and clinic settings reduced future C. trachomatis/N. gonorrhoeae diagnoses. After the Centers for Disease Control and Prevention's recommendations demonstrated a 41% decline in sexually transmitted infections; 3 tests in 1 year resulted in a 10% decline.

Predictors of Internet Health Information-Seeking Behaviors Among Young Adults Living With HIV Across the United States: Longitudinal Observational Study.

BACKGROUND: Consistent with young adults' penchant for digital communication, young adults living with HIV use digital communication media to seek out health information. Understanding the types of health information sought online and the characteristics of these information-seeking young adults is vital when designing digital health interventions for them. OBJECTIVE: This study aims to describe characteristics of young adults living with HIV who seek health information through the internet. Results will be relevant to digital health interventions and patient education. METHODS: Young adults with HIV (aged 18-34 years) self-reported internet use during an evaluation of digital HIV care interventions across 10 demonstration projects in the United States (N=716). Lasso (least absolute shrinkage and selection operator) models were used to select characteristics that predicted whether participants reported seeking general health and sexual and reproductive health (SRH) information on the internet during the past 6 months. RESULTS: Almost a third (211/716, 29.5%) and a fifth (155/716, 21.6%) of participants reported searching for general health and SRH information, respectively; 26.7% (36/135) of transgender young adults with HIV searched for gender-affirming care topics. Areas under the curve (>0.70) indicated success in building models to predict internet health information seeking. Consistent with prior studies, higher education and income predicted health information seeking. Higher self-reported antiretroviral therapy adherence, substance use, and not reporting transgender gender identity also predicted health information seeking. Reporting a sexual orientation other than gay, lesbian, bisexual, or straight predicted SRH information seeking. CONCLUSIONS: Young adults living with HIV commonly seek both general health and SRH information online, particularly those exploring their sexual identity. Providers should discuss the most commonly sought SRH topics and the use of digital technology and be open to discussing information found online to better assist young adults with HIV in finding accurate information. Characteristics associated with health information-seeking behavior may also be used to develop and tailor digital health interventions for these young adults.

"We Cannot Avoid Drinking": Alcohol Use among Female Entertainment Workers in Cambodia.

Background: Female entertainment workers (FEWs) in Cambodia work in predominantly alcohol-based venues and therefore may face occupational risks. Studies have suggested that FEWs are pressured to consume alcohol while at the workplace, which may have adverse health outcomes. This study aims to explore the experiences of alcohol use among FEWs in Cambodia. Methods: Twenty-seven focus group discussions (FGDs) with FEWs were conducted across five sites in four provinces in Cambodia. FGD participants were FEWs who worked at entertainment venues, including karaoke TV bars, beer gardens, and massage parlors, as well as women who worked as on-call or street-based sex workers, and women across entertainment venues who were parenting. Results: The authors modified a conceptual model to create a framework based on the major themes identified within the FGDs on autonomy in alcohol use among FEWs. The framework and thematic components highlight the continuum of autonomy from pressured or coerced alcohol use to, economically or socially rational alcohol use to voluntary alcohol use. Factors that impacted alcohol use across the spectrum include experiencing an economic shock, needing to maintain a livelihood, experiencing psychological distress, having the desire to thrive in employment environment and drinking socially for personal enjoyment. Conclusion/Importance: Much of the motivation behind alcohol use is related to the need for economic security. For women who do not have other employment or income-generating options, individual behavior change programing is unlikely to be effective. Structural changes are needed to improve the health and safety of FEWs in Cambodia.

Qualitative Evaluation of Social Media and Mobile Technology Interventions Designed to Improve HIV Health Outcomes for Youth and Young Adults Living With HIV: A HRSA SPNS Initiative.

Youth and young adults living with HIV (YYALH) are less likely to be engaged in HIV care, adhere to their medications, and achieve viral suppression compared to older adult populations. In the United States, the majority of YYALH belong to racial/ethnic, sexual, and gender minority groups. HIV care interventions are needed that specifically target YYALH and that exploit the use of social media and mobile technology (SMMT) platforms, where youth and young adults have a ubiquitous presence. We conducted a qualitative evaluation of SMMT interventions included in a Health Resources and Services Administration Special Projects of National Significance initiative designed to improve medical care engagement, retention, and medication adherence to achieve viral suppression among YYALH. However, in this study, only young adults living with HIV (YALH) ages 18 to 34 years participated. A total of 48 YALH were interviewed. The data were analyzed using thematic analysis and revealed three main themes supporting the usefulness of the SMMT interventions, which included (1) acceptability of SMMT interventions in managing HIV care with subthemes of medical information accessibility, reminders, and self-efficacy; (2) feelings of support and personal connection afforded by SMMT interventions; and (3) SMMT interventions help to alleviate negative feelings about status and mitigate HIV-related stigma. A few participants identified problems with using their respective intervention, primarily related to the functionality of the technologies. Overall, findings from our qualitative evaluation suggest that SMMT-based interventions have the potential to increase engagement and retention in care, support YALH in adhering to medication, and help them adjust to their diagnosis.

Theory-Based Text-Messaging to Reduce Methamphetamine Use and HIV Sexual Risk Behaviors Among Men Who Have Sex with Men: Automated Unidirectional Delivery Outperforms Bidirectional Peer Interactive Delivery.

Project Tech Support2 was a randomized controlled trial that tested three methods of text message delivery for reducing methamphetamine use and HIV risks among MSM. From March 2014 to January 2016, 286 methamphetamine-using MSM were randomized into: (1) interactive text conversations with Peer Health Educators, plus five-times-a-day automated theory-based messages, plus a weekly self-monitoring text-message assessment (TXT-PHE; n = 94); or, (2) the daily automated messages and weekly self-monitoring assessment (TXT-Auto; n = 99); or, (3) weekly self-monitoring assessment only (AO; n = 93). All three conditions demonstrated reductions in methamphetamine use (coef. = - 0.10), sex on methamphetamine (coef. = - 0.09), and condomless anal intercourse (CAI) with casual male partners (coef. = - 0.06). Only participants in TXT-PHE and TEXT-Auto also reduced CAI with main male partners (coefTXT-PHE = - 0.19; coef.TXT-Auto = - 0.16), and only TEXT-Auto participants reduced CAI with anonymous male partners (coef. = - 0.05). Additionally, both theory-based text-messaging interventions achieved sustained reductions in five of the six outcomes through 9 months. Overall, automated delivery outperformed peer-delivered messaging.

Associations between sociodemographic characteristics and substance use disorder severity among methamphetamine-using men who have sex with men.

Background: Men who have sex with men (MSM) have elevated rates of substance use disorders (SUDs) and differences across sociodemographic sub-groups of MSM are associated with a greater risk of deleterious outcomes. Although studies have shown that MSM report greater rates of polysubstance use relative to other adult populations, the associations between sociodemographic characteristics and both acute substance use and substance use severity among methamphetamine-using MSM are unknown. Objectives: The present study examines associations between sociodemographic characteristics and (a) recent substance use and (b) SUD severity. Method: From March 2014 to January 2016, 286 methamphetamine-using MSM were recruited to complete a baseline Audio Computer-Assisted Self-Interview (ACASI) assessment and the SCID MINI. Multivariable analyses employed generalized structural equation modeling given the non-continuous nature of the endogenous variables. Results: All measured sociodemographic characteristics except gay self-identification were significantly associated with recent substance use (all ps ≤ .05), and all characteristics except current homelessness were significantly associated with diagnostic SUD severity (all ps ≤ .05). However, nuanced risks were observed in participants' use of specific substances regarding recent substance use and substance use severity. Conclusion: These results suggest that multiple factors contribute to the risks of SUD severity among methamphetamine-using MSM. As such, these results are useful in the tailoring of clinical and psychosocial intervention strategies that serve this and other high-risk populations.