Our Research

Scroll down to view a sample of the research conducted by the Center’s faculty and students over the last several years.

 

2015

Akhtar-Khaleel, W. Z., Cook, R. L., Shoptaw, S., Surkan, P., Stall, R., Beyth, R. J., Plankey, M. (2015). Trends and Predictors of Cigarette Smoking Among HIV Seropositive and Seronegative Men: The Multicenter Aids Cohort Study. AIDS Behav. doi:10.1007/s10461-015-1099-6

We measured the trend of cigarette smoking among HIV-seropositive and seronegative men over time from 1984 to 2012. Additionally, we examined the demographic correlates of smoking and smoking consumption. Six thousand and five hundred and seventy seven men who have sex with men (MSM) from the Multicenter AIDS Cohort Study (MACS) were asked detailed information about their smoking history since their visit. Prevalence of smoking and quantity smoked was calculated yearly from 1984 to 2012. Poisson regression with robust error variance was used to estimate prevalence ratios of smoking in univariate and multivariate models. In 2012, 11.8 and 36.9 % of men who were enrolled in the MACS before 2001 or during or after 2001 smoked cigarettes, respectively. In the multivariate analysis, black, non-Hispanic, lower education, enrollment wave, alcohol use, and marijuana use were positively associated with current smoking in MSM. HIV serostatus was not significant in the multivariate analysis. However, HIV variables, such as detectable viral load, were positively associated. Though cigarette smoking has declined over time, the prevalence still remains high among subgroups. There is still a need for tailored smoking cessation programs to decrease the risk of smoking in HIV-seropositive MSM.

Andersen, J. P., Zou, C., & Blosnich, J. (2015). Multiple early victimization experiences as a pathway to explain physical health disparities among sexual minority and heterosexual individuals. Soc Sci Med, 133, 111-119. doi:10.1016/j.socscimed.2015.03.043

Prior research shows that health disparities exist between sexual minority and heterosexual individuals. We extend the literature by testing if the higher prevalence of childhood victimization experienced by sexual minority individuals accounts for lifetime health disparities. Heterosexual (n = 422) and sexual minority (n = 681) participants were recruited on-line in North America. Respondents completed surveys about their childhood victimization experiences (i.e., maltreatment by adults and peer victimization) and lifetime physician-diagnosed physical health conditions. Results showed that sexual minority individuals experienced higher prevalence of childhood victimization and lifetime physical health problems than heterosexuals. Mediation analyses indicated that maltreatment by adults and peer bullying explained the health disparities between sexual minority individuals and heterosexuals. This study is the first to show that multiple childhood victimization experiences may be one pathway to explain lifetime physical health disparities. Intervention programs reducing the perpetration of violence against sexual minority individuals are critical to reduce health care needs related to victimization experiences.

Baral, S. D., Friedman, M. R., Geibel, S., Rebe, K., Bozhinov, B., Diouf, D., Caceres, C. F. (2015). Male sex workers: practices, contexts, and vulnerabilities for HIV acquisition and transmission. Lancet, 385(9964), 260-273. doi: 10.1016/s0140-6736(14)60801-1

Male sex workers who sell or exchange sex for money or goods encompass a very diverse population across and within countries worldwide. Information characterising their practices, contexts where they live, and their needs is limited, because these individuals are generally included as a subset of larger studies focused on gay men and other men who have sex with men (MSM) or even female sex workers. Male sex workers, irrespective of their sexual orientation, mostly offer sex to men and rarely identify as sex workers, using local or international terms instead. Growing evidence indicates a sustained or increasing burden of HIV among some male sex workers within the context of the slowing global HIV pandemic. Several synergistic facilitators could be potentiating HIV acquisition and transmission among male sex workers, including biological, behavioural, and structural determinants. Criminalisation and intersectional stigmas of same-sex practices, commercial sex, and HIV all augment risk for HIV and sexually transmitted infections among male sex workers and reduce the likelihood of these people accessing essential services. These contexts, taken together with complex sexual networks among male sex workers, define this group as a key population underserved by current HIV prevention, treatment, and care services. Dedicated efforts are needed to make those services available for the sake of both public health and human rights. Evidence-based and human rights-affirming services dedicated specifically to male sex workers are needed to improve health outcomes for these men and the people within their sexual networks.

Bauermeister, J. A., Eaton, L., Meanley, S., & Pingel, E. S. (2015). Transactional Sex With Regular and Casual Partners Among Young Men Who Have Sex With Men in the Detroit Metro Area. Am J Mens Health. doi:10.1177/1557988315609110

Transactional sex refers to the commodification of the body in exchange for shelter, food, and other goods and needs. Transactional sex has been associated with negative health outcomes including HIV infection, psychological distress, and substance use and abuse. Compared with the body of research examining transactional sex among women, less is known about the prevalence and correlates of transactional sex among men. Using data from a cross-sectional survey of young men who have sex with men (ages 18-29) living in the Detroit Metro Area (N = 357; 9% HIV infected; 49% Black, 26% White, 16% Latino, 9% Other race), multivariate logistic regression analyses examined the association between transactional sex with regular and casual partners and key psychosocial factors (e.g., race/ethnicity, education, poverty, relationship status, HIV status, prior sexually transmitted infections [STIs], mental health, substance use, and residential instability) previously identified in the transactional sex literature. Forty-four percent of the current sample reported engaging in transactional sex. Transactional sex was associated with age, employment status, relationship status, and anxiety symptoms. When stratified, transactional sex with a regular partner was associated with age, educational attainment, employment status, relationship status, anxiety, and alcohol use. Transactional sex with a casual partner was associated with homelessness, race/ethnicity, employment status, and hard drug use. The implications of these findings for HIV/STI prevention are discussed, including the notion that efforts to address HIV/STIs among young men who have sex with men may require interventions to consider experiences of transactional sex and the psychosocial contexts that may increase its likelihood.

Bauermeister, J. A., Pingel, E. S., Jadwin-Cakmak, L., Meanley, S., Alapati, D., Moore, M., Harper, G. W. (2015). The use of mystery shopping for quality assurance evaluations of HIV/STI testing sites offering services to young gay and bisexual men. AIDS Behav, 19(10), 1919-1927. doi:10.1007/s10461-015-1174-z

Young men who have sex with men (YMSM) are at increased risk for HIV and STI infection. While encouraging HIV and STI testing among YMSM remains a public health priority, we know little about the cultural competency of providers offering HIV/STI tests to YMSM in public clinics. As part of a larger intervention study, we employed a mystery shopper methodology to evaluate the LGBT cultural competency and quality of services offered in HIV and STI testing sites in Southeast Michigan (n = 43).We trained and deployed mystery shoppers (n = 5) to evaluate the HIV and STI testing sites by undergoing routine HIV/STI testing. Two shoppers visited each site, recording their experiences using a checklist that assessed 13 domains, including the clinic’s structural characteristics and interactions with testing providers. We used the site scores to examine the checklist’s psychometric properties and tested whether site evaluations differed between sites only offering HIV testing (n = 14) versus those offering comprehensive HIV/STI testing (n = 29). On average, site scores were positive across domains. In bivariate comparisons by type of testing site, HIV testing sites were more likely than comprehensive HIV/STI testing clinics to ascertain experiences of intimate partner violence, offer action steps to achieve safer sex goals, and provide safer sex education. The developed checklist may be used as a quality assurance indicator to measure HIV/STI testing sites’ performance when working with YMSM. Our findings also underscore the need to bolster providers’ provision of safer sex education and behavioral counseling within comprehensive HIV/STI testing sites.

Bauermeister, J., Giguere, R., Dolezal, C., Leu, C. S., Febo, I., Cranston, R. D., . . . Carballo-Dieguez, A. (2016). To Use a Rectal Microbicide, First Insert the Applicator: Gel and Applicator Satisfaction Among Young Men Who Have Sex With Men. AIDS Educ Prev, 28(1), 1-10. doi:10.1521/aeap.2016.28.1.1

We examined how experiences with a rectal placebo gel and applicator used with receptive anal intercourse (RAI) related to young men who have sex with men’s (YMSM) likelihood of using a rectal microbicide gel and applicator in the future. An ethnically diverse sample of 95 YMSM (aged 18 to 30 years) were asked to insert hydroxyethylcellulose (HEC) placebo gel rectally before RAI during 12 weeks and report the product’s acceptability (i.e., satisfaction with applicator and gel, respectively; perceived gel side effects; and sexual satisfaction when gel was used) and likelihood of future microbicide use. Main and interaction effects predicting future use intentions were tested using linear regression. We found a positive association between future use intentions and applicator satisfaction (b = .33, p < .001). In a subsequent interaction effects model, we found that greater gel satisfaction was associated with increased future use intentions; however, the strength of this relationship was magnified when YMSM reported greatest satisfaction with the rectal applicator. Applicator satisfaction may be a salient factor in YMSM’s decision-making to use a rectal microbicide in the future. Although the importance of developing a satisfactory rectal microbicide gel for YMSM is undeniable for its future use, our results also emphasize the importance of developing strategies that increase YMSM’s comfort and skill when using a rectal applicator. Future research examining how to optimize the design, properties, and characteristics of a rectal applicator as a strategy to promote greater satisfaction and use among YMSM is merited.

Bien, C. H., Best, J. M., Muessig, K. E., Wei, C., Han, L., & Tucker, J. D. (2015). Gay Apps for Seeking Sex Partners in China: Implications for MSM Sexual Health. AIDS Behav. doi: 10.1007/s10461-014-0994-6

Anti-gay stigma and harsh local environments in many low and middle-income countries (LMIC) encourage men who have sex with men (MSM) partner-seeking mobile application (gay app) use. To investigate the sexual risk profiles of gay app users and guide future HIV prevention programs, we conducted a cross-sectional online survey among 1,342 MSM in China examining associations between gay app use and sexual behaviors, including HIV and sexually transmitted disease testing. Compared to non-app users, app users were more likely to be younger, better educated, “out” about their sexual orientation, and single. They were also more likely to report multiple recent sex partners and HIV testing, but there was no difference in condomless sex between the two groups. Future research among MSM in LMIC is needed to characterize gay app use and explore its potential for future public health interventions.

Blosnich, J. R., & Andersen, J. P. (2015). Thursday’s child: the role of adverse childhood experiences in explaining mental health disparities among lesbian, gay, and bisexual US adults. Soc Psychiatry Psychiatr Epidemiol, 50(2), 335-338. doi: 10.1007/s00127-014-0955-4

This study examined how adverse childhood experiences (ACE) may explain disparities in poor mental health between lesbian, gay, and bisexual (LGB), and heterosexual adults. Data are from three US states’ 2010 behavioral risk factor surveillance system surveys (n = 20,060) that included sexual orientation, ACE inventory, and mental distress. LGB status was significantly associated with mental distress (OR = 1.85 [1.14-3.02]). Once incorporating ACE scores into the multiple regression analysis, LGB status was no longer associated with mental distress (OR = 1.28 [0.76-2.16]). The results corroborate previous research that LGB individuals report greater prevalence of childhood adversity than their heterosexual peers, which may explain LGB adulthood health disparities.

Blosnich, J. R., Marsiglio, M. C., Gao, S., Gordon, A. J., Shipherd, J. C., Kauth, M., . . . Fine, M. J. (2016). Mental Health of Transgender Veterans in US States With and Without Discrimination and Hate Crime Legal Protection. Am J Public Health, e1-e7. doi:10.2105/ajph.2015.302981

OBJECTIVES: To examine whether indicators of community- and state-level lesbian, gay, bisexual, and transgender equality are associated with transgender veterans’ mental health. METHODS: We extracted Veterans Administration data for patients who were diagnosed with gender identity disorder, had at least 1 visit in 2013, and lived in a zip code with a Municipality Equality Index score (n = 1640). We examined the associations of whether a state included transgender status in employment nondiscrimination laws and in hate crimes laws with mood disorders; alcohol, illicit drug, and tobacco use disorders; posttraumatic stress disorder; and suicidal ideation or attempt. RESULTS: Nearly half (47.3%) of the sample lived in states with employment discrimination protection, and 44.8% lived in states with hate crimes protection. Employment nondiscrimination protection was associated with 26% decreased odds of mood disorders (adjusted odds ratio [AOR] = 0.74; 95% confidence interval [CI] = 0.59, 0.93) and 43% decreased odds of self-directed violence (AOR = 0.57; 95% CI = 0.34, 0.95). CONCLUSIONS: Understanding lesbian, gay, bisexual, and transgender social stressors can inform treatment and care coordination for transgender populations. (Am J Public Health. Published online ahead of print January 21, 2016: e1-e7. doi:10.2105/AJPH.2015.302981).

Blosnich, J. R., Gordon, A. J., & Fine, M. J. (2015). Associations of sexual and gender minority status with health indicators, health risk factors, and social stressors in a national sample of young adults with military experience. Ann Epidemiol, 25(9), 661-667. doi:10.1016/j.annepidem.2015.06.001

PURPOSE: To assess the associations of self-identified lesbian, gay, bisexual, and questioning sexual orientation or transgender status (LGBTQ) and military experience with health indicators. METHODS: We used data from the Fall 2012 National College Health Assessment. The survey included self-identified sociodemographic characteristics, mental (e.g., depression) and physical (e.g., human immunodeficiency virus) conditions, health risk behaviors (e.g., smoking), and social stressors (e.g., victimization). We used modified Poisson regression models, stratified by self-reported military service, to examine LGBTQ-related differences in health indicators, whereas adjusting for sociodemographic characteristics. RESULTS: Of 27,176 in the sample, among the military-experienced group, LGBTQ individuals had increased adjusted risks of reporting a past-year suicide attempt (adjusted risk ratio [aRR] = 4.37; 95% confidence interval [CI] = 1.39-13.67), human immunodeficiency virus (aRR = 9.90; 95% CI = 1.04-79.67), and discrimination (aRR = 4.67; 95% CI = 2.05-10.66) than their non-LGBTQ peers. Among LGBTQ individuals, military experience was associated with a nearly four-fold increased risk of reporting a past-year suicide attempt (aRR = 3.61; 95% CI = 1.46-8.91) adjusting for age, sex, race and ethnicity, marital status, depression, and other psychiatric diagnoses. CONCLUSIONS: Military experience may moderate health indicators among LGBTQ populations, and likewise, LGBTQ status likely modifies health conditions among military-experienced populations. Results suggest that agencies serving military populations should assess how and if the health needs of LGBTQ individuals are met.

Blosnich, J. R., Nasuti, L. J., Mays, V. M., & Cochran, S. D. (2016). Suicidality and sexual orientation: Characteristics of symptom severity, disclosure, and timing across the life course. Am J Orthopsychiatry, 86(1), 69-78. doi:10.1037/ort0000112  

This investigation explored suicide-related characteristics and help-seeking behavior by sexual orientation. Population-based data are from the California Quality of Life Surveys, which included 1,478 sexual minority (lesbian, gay, bisexual, and homosexually experienced individuals) and 3,465 heterosexual individuals. Bisexual women had a nearly six-fold increased risk of lifetime suicide attempts than heterosexual women (RR = 5.88, 95%CI: 3.89-8.90), and homosexually experienced men had almost 7 times higher risk of lifetime suicide attempts than heterosexual men (RR = 6.93, 95%CI: 3.65-13.15). Sexual minority men and women were more likely than heterosexual men and women to have disclosed suicide attempts to a medical professional (RR = 1.48 and RR = 1.44, respectively). Among persons who ever attempted suicide, sexual minority women had a younger age of index attempt than heterosexual women (15.9 vs. 19.6 years of age, respectively). Healthcare professionals should be aware of suicidal risk heterogeneity among sexual minority individuals, including vulnerable points of risk and evidenced-based treatments. (PsycINFO Database Record.

Cheung, D. H., Lim, S. H., Guadamuz, T. E., Koe, S., & Wei, C. (2015). The Potential Role of Circuit Parties in the Spread of HIV Among Men Who Have Sex with Men in Asia: A Call for Targeted Prevention. Arch Sex Behav, 44(2), 389-397. doi: 10.1007/s10508-014-0339-6

We postulated that the growing popularity of circuit parties may play a role in the escalating HIV prevalence among men who have sex with men (MSM) in Asia. The present study is the first to characterize the sociodemographic and HIV-related behavioral factors of circuit party attendees living in Asia. We analyzed a subset of data from the Asia Internet MSM Sex Survey conducted from January 1 to February 28, 2010. Inclusion criteria included: being biologically male, aged 18 years or above, self-reported sex with another man, and reported international travel in the past 6 months (N = 6,094). From our multivariable logistic regression model, participants’ resident country with low HIV prevalence (among MSM) (AOR 1.59, 95 % CI 1.27-2.00) and country of destination with high HIV prevalence were independently associated with higher odds of circuit party attendance (AOR 1.32, 95 % CI 1.14-1.53) during international travel. Statistical interaction indicated circuit party attendees were likely to have traveled from low HIV prevalence (among MSM) countries to high HIV prevalence countries (AOR 1.40, 95 % CI 1.20-1.64). Other independent correlates included unprotected anal sex with a male casual sex partner and recreational drug use during travel. HIV and STI prevention focusing on circuit party attendees may have a pivotal role on the spread of the HIV epidemics among MSM in Asia.

Coulter, R. W., Blosnich, J. R., Bukowski, L. A., Herrick, A. L., Siconolfi, D. E., & Stall, R. D. (2015). Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults. Drug Alcohol Depend, 154, 251-259. doi:10.1016/j.drugalcdep.2015.07.006

BACKGROUND: Little is known about differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified populations. Using data from a large-scale health survey, we compare the drinking patterns and prevalence of alcohol-related problems of transgender-identified individuals to nontransgender-identified males and females. For transgender-identified people, we examine how various forms of victimization relate to heavy episodic drinking (HED). METHODS: Cross-sectional surveys were completed by 75,192 students aged 18-29 years attending 120 post-secondary educational institutions in the United States from 2011 to 2013. Self-reported measures included alcohol use, alcohol-related problems, victimization, and sociodemographics, including 3 gender-identity groups: transgender-identified individuals; nontransgender-identified males; and nontransgender-identified females. RESULTS: Compared to transgender-identified individuals, nontransgender-identified males were more likely to report HED in the past 2 weeks (relative risk=1.42; p=0.006); however, nontransgender-identified males and females reported HED on fewer days than transgender-identified people (incidence-rate ratios [IRRs] ranged from 0.28 to 0.43; p-values<0.001). Compared to transgender-identified people, nontransgender-identified males and females had lower odds of past-year alcohol-related sexual assault and suicidal ideation (odds ratios ranged from 0.24 to 0.45; p-values<0.05). Among transgender-identified people, individuals who were sexually assaulted (IRR=3.21, p=0.011) or verbally threatened (IRR=2.42, p=0.021) in the past year had greater HED days than those who did not experience those forms of victimization. CONCLUSIONS: Compared to transgender-identified people, nontransgender-identified males and females: have fewer HED occasions (despite nontransgender-identified males having greater prevalence of HED); and are at lower risk for alcohol-related sexual assaults and suicidal ideation. Experiences of sexual assault and verbal threats are associated with greater HED occasions for transgender-identified people.

Coulter, R. W., Herrick, A. L., Friedman, M. R., & Stall, R. D. (2016). Sexual-Orientation Differences in Positive Youth Development: The Mediational Role of Bullying Victimization. Am J Public Health, e1-e7. doi:10.2105/ajph.2015.303005

OBJECTIVES: To examine sexual-orientation differences in positive youth development, and how bullying victimization mediated these differences in a sample of adolescents. METHODS: In 2007 to 2008, positive youth development was measured in 1870 adolescents from US schools and after-school programs in 45 states by using the validated Five Cs model of competence, confidence, connection, character, and caring/compassion. Sexual-minority youths (6.8%) reported having same- or both-gender sexual attractions. Nonattracted youths (4.2%) reported having no sexual attractions. RESULTS: Compared with sexual-minority youths, heterosexual and nonattracted youths had lower odds of being a victim of bullying. Heterosexual and nonattracted youths also had higher average scores in competence, confidence, and connection, but these associations between sexual orientation and positive youth development scores were partly attributable to lack of bullying victimization. CONCLUSIONS: Designing, implementing, and evaluating interventions that reduce bullying can give sexual-minority youths access to several building blocks of health and well-being. (Am J Public Health. Published online ahead of print January 21, 2016: e1-e7. doi:10.2105/AJPH.2015.303005).

Coulter, R. W., Kenst, K. S., Bowen, D. J., & Scout. (2015). Coulter et al. respond. Am J Public Health, 105 Suppl 3, e2-3. doi:10.2105/ajph.2014.302316

Coulter, R. W., Kinsky, S. M., Herrick, A. L., Stall, R. D., & Bauermeister, J. A. (2015). Evidence of Syndemics and Sexuality-Related Discrimination Among Young Sexual-Minority Women. LGBT Health, 2(3), 250-257. doi:10.1089/lgbt.2014.0063

PURPOSE: Syndemics, or the co-occurrence and interaction of health problems, have been examined extensively among young men who have sex with men, but their existence remain unexamined, to our knowledge, among sexual-minority (i.e., lesbian, gay, and bisexual) women. Thus, we investigated if syndemics were present among young sexual-minority women, and if sexual-orientation discrimination was an independent variable of syndemic production. METHODS: A total of 467 sexual-minority women between the ages of 18 and 24 completed a cross-sectional online survey regarding their substance use, mental health, sexual behaviors, height, weight, and experiences of discrimination. We used structural equation modeling to investigate the presence of syndemics and their relationship to sexual-orientation discrimination. RESULTS: Heavy episodic drinking, marijuana use, ecstasy use, hallucinogen use, depressive symptoms, multiple sexual partners, and history of sexually transmitted infections (STIs) comprised syndemics in this population (chi-square=24.989, P=.201; comparative fit index [CFI]=0.946; root mean square error of approximation [RMSEA]=0.023). Sexual-orientation discrimination is significantly and positively associated with the latent syndemic variable (unstandardized coefficient=0.095, P<.05), and this model fit the data well (chi-square=33.558, P=.059; CFI=0.914; RMSEA=0.029). The reverse causal model showed syndemics is not an independent variable of sexual-orientation discrimination (unstandardized coefficient=0.602, P>.05). CONCLUSIONS: Syndemics appear to be present and associated with sexual-orientation discrimination among young sexual-minority women. Interventions aimed at reducing discrimination or increasing healthy coping may help reduce substance use, depressive symptoms, and sexual risk behaviors in this population.

Coulter, R. W., Marzell, M., Saltz, R., Stall, R., & Mair, C. (2016). Sexual-orientation differences in drinking patterns and use of drinking contexts among college students. Drug Alcohol Depend. doi:10.1016/j.drugalcdep.2016.01.006

BACKGROUND: Evidence suggests there are important sexual-orientation differences in alcohol consumption, particularly among women. Little is known about where gay/lesbian and bisexual college students drink or differences in drinking patterns derived from graduated frequency measures between heterosexual, gay/lesbian, and bisexual students. The goal of this analysis was to examine patterns of alcohol consumption-including drinking prevalence, quantity, frequency, and contexts of use-by sexual orientation. METHODS: Data on sexual identity, gender, drinking behaviors, and drinking contexts were examined from repeated cross-sectional samples of undergraduate students attending 14 public California universities from 2003-2011 (n=58,903). Multivariable statistical techniques were employed to examine sexual-orientation differences stratified by gender. RESULTS: Gay males, lesbians, and bisexual females were significantly more likely to report drinking alcohol in the current semester than their same-gender heterosexual peers (relative risks ranged from 1.07 to 1.10, p-values <0.01). Among current drinkers, bisexual females consumed 7 or more drinks and lesbians consumed 10 or more drinks on significantly more days than heterosexual females. On the other hand, gay male drinkers consumed 8 or more drinks on significantly fewer days than heterosexual male drinkers. Compared to their same-gender heterosexual peers: lesbian/gay and bisexual students drank less frequently at Greek parties (incidence rate ratios [IRRs] ranged from 0.52 to 0.73, p-values <0.01); lesbians (IRR=0.84, p=0.043) and bisexual males (IRR=0.82, p=0.009) drank less frequently at off-campus parties; and gay males drank more frequently outdoors (IRR=1.63, p<0.001) and at bars/restaurants (IRR=1.21, p=0.013). CONCLUSIONS: Alcohol prevention programs and future research should consider sexual-orientation differences in drinking patterns and use of drinking contexts.

Cranston, R. D., Althouse, A. D., van Griensven, F., Janocko, L., Curlin, M. E., Chaikummao, S., McGowan, I. (2015). Prevalence of Anal Human Papillomavirus Vaccine Types in the Bangkok Men Who Have Sex With Men Cohort Study. Sex Transm Dis, 42(12), 671-676. doi:10.1097/olq.0000000000000372

BACKGROUND: The quadrivalent human papillomavirus (qHPV) and 9 valent (nHPV) vaccine are licensed for males to prevent anal HPV-associated dysplasia and cancer caused by HPV types 6, 11, 16, and 18 (qHPV) and additional types 33, 35, 45, 52, and 58 (nHPV), respectively. Both conditions are common in HIV-infected and HIV-uninfected men who have sex with men (MSM). It is not well documented which anal HPV vaccine types are most prevalent in Southeast Asia. METHODS: A convenience sample of 400 anal swabs were obtained from 200 HIV-infected and 200 HIV-uninfected sexually active Bangkok MSM Cohort Study participants. After swab collection in PreservCyt (Cytyc Corp, Marlborough, MA), the media was stored at -80 degrees C until processing. DNA was extracted, amplified by polymerase chain reaction, denatured, and then hybridized to probes for 37 HPV types and beta-globin. RESULTS: The mean participant age was 25.6 years (range, 18-55 years); the mean CD4 T-cell count was 410 cells/mm in the HIV-infected participants. Among all swab samples, 386 (192 HIV-positive and 194 HIV-negative) had adequate beta-globin for HPV genotype testing. Anal HPV type was detected in 44.3% of participants whose samples underwent genotype testing. Both qHPV and nHPV types were more frequently detected in HIV-infected compared with HIV-uninfected (42.2% vs. 23.2% [P < 0.01], 50.0% vs. 24.2% [P < 0.01]), respectively). There were no significant relationships between social behaviors (alcohol use, drug use) or sexual behaviors (number of partners, condom usage, sexual positioning) and anal HPV prevalence. CONCLUSIONS: The prevalence of anal vaccine HPV types in Thai MSM was similar to that reported in MSM from Western populations and has a similar distribution by HIV status. Targeting young MSM with vaccination could offer protection against HPV vaccine types.

Dolezal, C., Frasca, T., Giguere, R., Ibitoye, M., Cranston, R. D., Febo, I., . . . Carballo-Dieguez, A. (2015). Awareness of Post-Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP) Is Low but Interest Is High Among Men Engaging in Condomless Anal Sex With Men in Boston, Pittsburgh, and San Juan. AIDS Educ Prev, 27(4), 289-297. doi:10.1521/aeap.2015.27.4.289

This study examines awareness of and experiences with post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) among 228 men recruited in Boston, Pittsburgh, and San Juan between 12/2010 and 6/2012. All of them reported having condomless anal sex with a man in the prior year. Overall, 41% had heard of PEP, ranging from 16% in San Juan to 64% in Boston. Only 21% had heard of PrEP, ranging from 8% in San Juan to 36% in Boston. Three had used PEP, and none had used PrEP. After the methods were described to participants, interest in both was high, with intentions to use PEP and PrEP respectively at 9.1 and 7.7 (10-point scale). Increased public education is needed to raise awareness of these HIV prevention methods, especially among MSM who acknowledge potential risk behavior. It also seems likely that many such men would use these methods once they become aware of them.

D’Souza, G., Wentz, A., Wiley, D., Shah, N., Barrington, F., Darragh, T. M., . . . Cranston, R. D. (2015). Anal Cancer Screening in Men Who Have Sex with Men in the Multicenter AIDS Cohort Study. J Acquir Immune Defic Syndr. doi:10.1097/qai.0000000000000910

OBJECTIVE: To evaluate the prevalence of anal cytology (ACyt) abnormalities among HIV-infected and HIV-uninfected men who have sex with men (MSM) DESIGN:: Multicenter cohort study of 723 HIV-infected and 788 HIV-uninfected MSM with ACyt, with a second ACyt collected two years later. Referral for high-resolution anoscopy (HRA) was suggested for abnormal ACyt. METHODS: ACyt samples were collected using a polyester swab and liquid cytology media, and read in a central laboratory. RESULTS: Prevalence of any abnormal ACyt was 25% in HIV-uninfected MSM, and increased to 38%, 41%, and 47% among HIV-infected MSM with current CD4+ T-cell counts >/=500, 350-499, and <350 cells/mm (p<0.001), respectively. Anal HPV16 DNA was also more common in HIV-infected than HIV uninfected MSM (25% vs 16%, p<0.001). Abnormal baseline ACyt together with prevalent HPV16 DNA detection was present in only 7% of HIV-uninfected MSM compared to 18% of HIV-infected MSM with current CD4<350, p<0.001).Among HIV-infected men, 56% of the men with low grade squamous intraepithelial lesions ASC-US/LSIL and 81% of men with atypical squamous cells cannot exclude high grade (ASC-H/)/high grade SIL (HSIL) had lower grade ACyt findings 18-30 months later (“regressed”). However, 19% of untreated HIV-infected men with ASC-H/HSIL cytology maintained that same grade of cytology at their second test approximately two years later, and 15% with ASC-US/LSIL “progressed” to ASC-H/HSIL. Abnormal ACyt had high sensitivity (96%) but low specificity (17%) for biopsy proven HSIL. CONCLUSIONS: Prevalence of abnormal ACyt remains elevated in HIV-infected men during the current ART era.

Elsesser, S. A., Oldenburg, C. E., Biello, K. B., Mimiaga, M. J., Safren, S. A., Egan, J. E., . . . Mayer, K. H. (2015). Seasons of Risk: Anticipated Behavior on Vacation and Interest in Episodic Antiretroviral Pre-exposure Prophylaxis (PrEP) Among a Large National Sample of U.S. Men Who have Sex with Men (MSM). AIDS Behav. doi:10.1007/s10461-015-1238-0

The current analysis evaluates interest in and acceptability of daily PrEP during short episodes of anticipated increased risk (i.e. Epi-PrEP). In 2013, U.S. members of an internet-based MSM sexual networking site were invited to complete a survey about HIV prevention practices in the context of vacationing. 7305 MSM responded to the survey. Of respondents who had vacationed in the past year, 25.6 % reported condomless anal sex (CAS) with new male sex partners while vacationing. Most (92.6 %) respondents agreed that having to use PrEP every day was a barrier to PrEP use and 74.3 % indicated they would take PrEP if they knew it would be helpful for short periods of anticipated increased risk. MSM who reported increased CAS while on vacation in the past year were more likely to indicate that they would take PrEP if it were helpful when used for short periods than respondents who did not (aOR = 2.02, 95 % CI 1.59-2.56, p < 0.001). Studies designed to evaluate uptake, adherence, and protective benefit of short PrEP courses are warranted.

Farmer, G. W., Blosnich, J. R., Jabson, J. M., & Matthews, D. D. (2015). Gay Acres: Sexual Orientation Differences in Health Indicators Among Rural and Nonrural Individuals. J Rural Health. doi:10.1111/jrh.12161

PURPOSE: Geographic location is a significant factor that influences health status and health disparities. Yet, little is known about the relationship between geographic location and health and health disparities among lesbian, gay, and bisexual (LGB) persons. This study used a US population-based sample to evaluate the associations of sexual orientation with health indicators by rural/nonrural residence. METHODS: Data were pooled from the 10 states that collected sexual orientation in the 2010 Behavioral Risk Factor Surveillance System surveys. Rural status was defined using metropolitan statistical area, and group differences by sexual orientation were stratified by gender and rural/nonrural status. Chi-square tests for categorical variables were used to assess bivariate relationships. Multivariable logistic regression models stratified by gender and rural/nonrural status were used to assess the association of sexual orientation to health indicators, while adjusting for age, race/ethnicity, education, and partnership status. All analyses were weighted to adjust for the complex sampling design. FINDINGS: Significant differences between LGB and heterosexual participants emerged for several health indicators, with bisexuals having a greater number of differences than gay men/lesbians. There were fewer differences in health indicators for rural LGB participants compared to heterosexuals than nonrural participants. CONCLUSIONS: Rural residence appears to influence the pattern of LGB health disparities. Future work is needed to confirm and identify the exact etiology or rural/nonrural differences in LGB health.

Frye, V., Nandi, V., Egan, J., Cerda, M., Greene, E., Van Tieu, H., . . . Koblin, B. A. (2015). Sexual Orientation- and Race-Based Discrimination and Sexual HIV Risk Behavior Among Urban MSM. AIDS Behav, 19(2), 257-269. doi: 10.1007/s10461-014-0937-2

Understanding what social factors are associated with risk of HIV acquisition and transmission among gay, bisexual and other men who have sex with men (MSM) is a critical public health goal. Experiencing discrimination may increase risk of HIV infection among MSM. This analysis assessed relations between experiences of sexual orientation- and race-based discrimination and sexual HIV risk behavior among MSM in New York City. 1,369 MSM completed a self-administered computerized assessment of past 3-month sexual behavior, experience of social discrimination and other covariates. Regression models assessed relations between recent experience of discrimination and sexual HIV risk behavior. Mean age was 32 years; 32 % were white; 32 % Latino/Hispanic; 25 % African American/Black. Of MSM who self-reported HIV-positive or unknown status (377), 7 % (N = 27) reported having unprotected insertive anal intercourse with an HIV-negative or unknown status partner (“HIV transmission risk”). Of MSM who self-reported HIV-negative status (992), 11 % (110) reported unprotected receptive anal intercourse with an HIV-positive or unknown status partner (“HIV acquisition risk”). HIV acquisition risk was positively associated with sexual orientation-based discrimination in home or social neighborhoods, but not race-based discrimination. We observed that sexual orientation-based discrimination was associated with sexual HIV risk behavior among urban-dwelling MSM. Addressing environmental sources of this form of discrimination, as well as the psychological distress that may result, should be prioritized in HIV prevention efforts.

Giguere, R., Dolezal, C., Bauermeister, J. A., Frasca, T., Valladares, J., Febo, I., . . . Carballo-Dieguez, A. (2015). Influence of Partner Type on Acceptability and Likelihood of Use of a Rectal Microbicide Among Young Men Who Have Sex With Men in the United States and Puerto Rico. J Sex Res, 1-9. doi:10.1080/00224499.2014.1002127

This study examined how acceptability of placebo gel with receptive anal intercourse (RAI) and likelihood of future rectal microbicide use varied across partner types. Because no rectal microbicide is available yet, use of placebo permitted the study of gel use behavior in real-life circumstances. A total of 87 men who have sex with men (MSM) aged 18 to 30 years inserted placebo gel rectally before RAI during 12 weeks. Using mixed-methods design, participants completed a behavioral questionnaire and in-depth interview. In all, 62 men (71.3%) reported gel use with a lover (i.e., spouse equivalent, boyfriend), 32 (36.8%) with a one-night stand (i.e., man with whom you had sex once), and 29 (33.3%) with an “other” male partner. While gel acceptability was high across partner types, use with lovers was facilitated by trust and familiarity; yet trust made participants believe protection was less necessary. Conversely, participants expressed high likelihood of using gel with one-night stands, whom they perceived as riskier; yet they felt less comfortable discussing gel with them, often resorting to covert use or forgoing gel. A successful microbicide will be positioned as a sexual pleasure enhancer so that men can present it to their lovers and other partners as a gel that improves sex and secondarily prevents human immunodeficiency virus (HIV).

Hart, T. A., Mustanski, B., Ryan, D. T., Gorbach, P. M., Stall, R. D., Surkan, P. J., & Plankey, M. (2015). Depression and Sexual Dysfunction Among HIV-Positive and HIV-Negative Men Who Have Sex With Men: Mediation by Use of Antidepressants and Recreational Stimulants. Arch Sex Behav, 44(2), 399-409. doi: 10.1007/s10508-014-0279-1

Erectile dysfunction and other forms of sexual dysfunction are highly prevalent among HIV+ men who have sex with men (MSM). Research has not previously identified the mechanisms by which depression may be associated with sexual dysfunction among HIV-positive and HIV-seronegative (HIV-negative) MSM. The present study examined the role of antidepressant use, stimulant use, and smoking as mediators of the relation between depression and sexual dysfunction among HIV-positive and HIV-negative MSM. Participants enrolled in the Multicenter AIDS Cohort Study, an ongoing prospective study of the natural and treated histories of HIV infection among MSM in the United States, completed a modified version of the International Index of Erectile Function for MSM. The study sample included 1,363 participants, with 619 HIV-positive men and 744 HIV-negative men. A structural equation model examined depression as a predictor of subsequent sexual dysfunction, mediated by antidepressant use, stimulant use, and smoking. Depression predicted subsequent sexual function among both HIV-negative and HIV-positive MSM. This effect appeared to be both a direct effect and an indirect effect via antidepressant use. Findings suggest that antidepressant medication use may partially explain sexual dysfunction among MSM.

Hirshfield, S., Schrimshaw, E. W., Stall, R. D., Margolis, A. D., Downing, M. J., Jr., & Chiasson, M. A. (2015). Drug Use, Sexual Risk, and Syndemic Production Among Men Who Have Sex With Men Who Engage in Group Sexual Encounters. Am J Public Health, e1-e10. doi: 10.2105/ajph.2014.302346

Objectives: We surveyed men who have sex with men (MSM) to determine whether sexual risk behaviors, recent drug use, and other psychosocial problems differed between men who engaged in one-on-one and group sexual encounters. Methods. We conducted an Internet-based cross-sectional survey of 7158 MSM aged 18 years or older in the United States recruited from a gay-oriented sexual networking Web site in 2008. Among MSM who engaged in group sexual encounters, we compared their past-60-day sexual behaviors in one-on-one encounters and group sexual encounters. We also compared risk profiles and syndemic production between men who did and did not participate in group sex. Results. Men reporting a group-sex encounter had significantly higher polydrug use and sexual risk than did the men not reporting group sex in the past 60 days. The odds of engaging in group sex with 4 or more sexual partners significantly increased with the number of psychosocial problems, supporting evidence of syndemic production. Conclusions: We identified a particularly high-risk subgroup in the MSM population with considerable psychosocial problems that may be reached online. Research is needed on how to engage these high-risk men in combination prevention interventions. (Am J Public Health. Published online ahead of print February 25, 2015: e1-e10. doi:10.2105/AJPH.2014.302346).

Hsu, H. K., Brown, T. T., Li, X., Young, S., Cranston, R. D., D’Souza, G., . . . Wiley, D. J. (2015). Association between free testosterone levels and anal human papillomavirus types 16/18 infections in a cohort of men who have sex with men. PLoS One, 10(3), e0119447. doi:10.1371/journal.pone.0119447

BACKGROUND: Human papillomavirus (HPV) types 16 and 18 cause invasive cervical cancer and most invasive anal cancers (IACs). Overall, IAC rates are highest among men who have sex with men (MSM), especially MSM with HIV infection. Testosterone is prescribed for men showing hypogonadism and HIV-related wasting. While there are direct and indirect physiological effects of testosterone in males, its role in anal HPV16/18 infections in men is unknown. METHODS: Free testosterone (FT) was measured in serum from 340 Multicenter AIDS Cohort Study (MACS) participants who were tested for anal HPV16/18-DNA approximately 36 months later. The effect of log10-transformed current FT level on anal HPV16/18 prevalence was modeled using Poisson regression with robust error variance. Multivariate models controlled for other HPV types, cumulative years of exogenous testosterone use, race, age, lifetime number of receptive anal intercourse partnerships, body mass index, tobacco smoking, HIV-infection and CD4+ T-cell counts among HIV-infected, and blood draw timing. RESULTS: Participants were, on average, 60 (+5.4) years of age, White (86%), and HIV-uninfected (56%); Twenty-four percent tested positive for anal HPV16 and/or 18-DNA (HPV16 prevalence=17.1%, HPV18=9.1%). In adjusted analysis, each half-log10 increase of FT was associated with a 1.9-fold (95% Confidence Interval: 1.11, 3.24) higher HPV16/18 prevalence. Additionally, other Group 1 high-risk HPVs were associated with a 1.56-fold (1.03, 2.37) higher HPV16/18 prevalence. Traditional risk factors for HPV16/18 infection (age, tobacco smoking; lifetime number of sexual partners, including the number of receptive anal intercourse partnerships within 24 months preceding HPV testing) were poorly correlated with one another and not statistically significantly associated with higher prevalence of HPV16/18 infection in unadjusted and adjusted analyses. CONCLUSIONS: Higher free testosterone was associated with increased HPV16/18 prevalence measured approximately three years later, independent of sexual behavior and other potential confounders. The mechanisms underlying this association remain unclear and warrant further study.

Lytle, M. C., De Luca, S. M., Blosnich, J. R., & Brownson, C. (2015). Associations of racial/ethnic identities and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning individuals. J Affect Disord, 178, 39-45. doi:10.1016/j.jad.2014.07.039

BACKGROUND: Our aim was to examine the associations of racial/ethnic identity and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning (LGBQ) and heterosexual college students. An additional aim was to determine the prevalence of passive suicidal ideation (i.e., death ideation) and active suicidal ideation among culturally diverse LGBQ individuals. METHODS: Data from the National Research Consortium probability-based sample of college students from 70 postsecondary institutions (n=24,626) were used to examine active and passive suicidal ideation in the past 12-months and lifetime active suicidal ideation among students by sexual orientation, racial/ethnic identity, and religious affiliation. RESULTS: Across most racial/ethnic groups and religious affiliations, LGBQ students were more likely to report active suicidal ideation than non-LGBQ individuals. Among LGBQ students, Latino individuals had lower odds of reporting both past 12-month passive and active suicidal ideation than their non-Hispanic white LGBQ counterparts. Compared to Christian LGBQ students, Agnostic/Atheist LGBQ individuals had greater odds of reporting past 12-month passive suicidal ideation, and Jewish LGBQ students were less likely to endorse past 12-month passive and active suicidal ideation. LIMITATIONS: Cross-sectional design and self-reported data. CONCLUSIONS: Results corroborate previous research showing elevated prevalence of suicidal ideation among LGBQ individuals in comparison to their heterosexual counterparts. These findings are among the first to document prevalence differences within the LGBQ population based on intersectional identities (race/ethnicity and religious affiliation). Providers should recognize that LGBQ individuals might need support in negotiating the complex relationship between multiple identities, especially due to their elevated prevalence of suicidal ideation.

Matthews, D. D., Herrick, A. L., Coulter, R. W., Friedman, M. R., Mills, T. C., Eaton, L. A., . . . Stall, R. D. (2016). Running Backwards: Consequences of Current HIV Incidence Rates for the Next Generation of Black MSM in the United States. AIDS Behav, 20(1), 7-16. doi:10.1007/s10461-015-1158-z

Black men who have sex with men (MSM) in the United States are disproportionately impacted by HIV. To better understand this public health problem, we reviewed the literature to calculate an estimate of HIV incidence among Black MSM. We used this rate to model HIV prevalence over time within a simulated cohort, which we subsequently compared to prevalence from community-based samples. We searched all databases accessible through PubMed, and Conference on Retroviruses and Opportunistic Infections abstracts for HIV incidence estimates among Black MSM. Summary HIV incidence rates and 95 % confidence intervals (CIs) were calculated using random effects models. Using the average incidence rate, we modeled HIV prevalence within a simulated cohort of Black MSM (who were all HIV-negative at the start) from ages 18 through 40. Based on five incidence rates totaling 2898 Black MSM, the weighted mean incidence was 4.16 % per year (95 % CI 2.76-5.56). Using this annual incidence rate, our model predicted that 39.94 % of Black MSM within the simulated cohort would be HIV-positive by age 30, and 60.73 % by 40. Projections were similar to HIV prevalence found in community-based samples of Black MSM. High HIV prevalence will persist across the life-course among Black MSM, unless effective prevention and treatment efforts are increased to substantially reduce HIV transmission among this underserved and marginalized population.

Meanley, S., Gale, A., Harmell, C., Jadwin-Cakmak, L., Pingel, E., & Bauermeister, J. A. (2015). The role of provider interactions on comprehensive sexual healthcare among young men who have sex with men. AIDS Educ Prev, 27(1), 15-26. doi: 10.1521/aeap.2015.27.1.15

Testing for both HIV and STIs is an essential component of comprehensive sexual healthcare for young men who have sex with men (YMSM). Using data collected from YMSM living in the Detroit metropolitan area (N = 304, ages 18-29; 51% Black, 25% White, 14% Latino), we examined YMSM’s access to a medical provider in the prior year and tested whether a provider’s conversation regarding HIV/STI prevention was associated with their type of testing behavior: Non-Testers, HIV-Only Testing, and HIV and STI Testing. Over half (56.7%) reported a routine provider visit in the previous year. Visits were associated with having insurance, provider comfort, and prior HIV and/or STI testing. Among YMSM who visited a doctor, our multinomial regression exhibited that those whose provider discussed HIV/STI prevention were most likely to have tested for both HIV and STIs, as compared to the HIV Only and Never Tester categories. Patient-provider communication regarding HIV/STI prevention is critical to motivate comprehensive sexual healthcare access among YMSM. Strategies that enable providers to discuss HIV/STI prevention with YMSM in a sex-positive manner may help maximize comprehensive testing.

Mimiaga, M. J., O’Cleirigh, C., Biello, K. B., Robertson, A. M., Safren, S. A., Coates, T. J., . . . Mayer, K. H. (2015). The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. J Acquir Immune Defic Syndr, 68(3), 329-336. doi:10.1097/qai.0000000000000475

BACKGROUND: Cross-sectional studies have suggested that co-occurring epidemics or “syndemics” of psychosocial health problems may accelerate HIV transmission among men who have sex with men (MSM) in the United States. We aimed to assess how 5 syndemic conditions (depressive symptoms, heavy alcohol use, stimulant use, polydrug use, and childhood sexual abuse) affected HIV incidence and sexual risk behavior over time. METHODS: Eligible men in a large prospective cohort of sexually active HIV-uninfected MSM completed HIV testing and behavioral surveys at baseline and every 6 months for 48 months. We examined interrelationships between psychosocial problems and whether these interactions increased the odds of HIV risk behaviors and risk of seroconversion over study follow-up. RESULTS: Among 4295 men, prevalence of psychosocial conditions was substantial at baseline and was positively associated with each other. We identified a statistically significant positive dose-response relationship between numbers of syndemic conditions and HIV seroconversion for all comparisons (with the greatest hazard among those with 4-5 conditions, adjusted hazard ratio = 8.69; 95% confidence interval: 4.78 to 15.44). The number of syndemic conditions also predicted increased HIV-related risk behaviors over time, which mediated the syndemic-HIV seroconversion association. CONCLUSIONS: The accumulation of syndemic psychosocial problems predicted HIV-related sexual risk behaviors and seroconversion in a large sample of US MSM. Given the high prevalence of syndemic conditions among MSM and the moderate effect sizes attained by traditional brief behavioral interventions to date, the HIV prevention agenda requires a shift toward improved assessment of psychosocial comorbidities and stronger integration with mental health and substance abuse treatment services.

Mosovsky, S., Nolan, B. A., Markovic, N., & Stall, R. (2016). RADICLE Moms Study: Minority Stress and Implications for Lesbian Mothers. Women Health. doi:10.1080/03630242.2016.1141827

Little is known about depressive symptoms among mothers who identify as lesbian. The aim of the Relationships And Depression In Childbearing LEsbian (RADICLE) Moms study was to investigate the minority stress model to determine if higher levels of social support altered the relationship between gay-specific minority stress and depressive symptoms in a sample of self-identified lesbian women who had one or more children less than 18 years of age living in the household. We hypothesized that social support would influence the relationship between depressive symptoms and minority stress. Participants (n = 131) completed an anonymous Internet survey between May and December, 2011. Controlling for demographic factors, independent hierarchical multiple regression analyses examined the relationships between depressive symptoms and social support, minority stress, and general stress. While each of these factors had a significantly positive relationship to depressive symptoms, stepwise regression analyses identified general stress as the most significant factor. Mediation analysis revealed that social support fully mediated the relationship between minority stress and depressive symptoms. This pilot study provides support for development of intervention strategies to decrease general stress and or increase social support among lesbian mothers.

Ortiz, K. S., Duncan, D. T., Blosnich, J. R., Salloum, R. G., & Battle, J. (2015). Smoking among sexual minorities: are there racial differences? Nicotine Tob Res. doi: 10.1093/ntr/ntv001

INTRODUCTION: Smoking prevalence is higher among sexual minorities compared to their heterosexual peers. However, very little is known about potential racial differences in smoking among sexual minority populations. We examined differences by race in smoking status among a robust sample of sexual minorities. METHODS: We used data from the 2010 Social Justice Sexuality (SJS) project, a large national convenience sample of sexual minority adults that oversampled individuals from racial minority groups. Log-Poisson multivariable regression models were employed to determine the risk of current smoking among sexual minority individuals by race after controlling for socio-demographic characteristics. RESULTS: Among smokers, 22.35% identified as white, 26.98% identified as Black, 19.38% identified as Latino/Hispanic, 5.58% identified as Asian American, and 25.67% were other/multiracial. In fully adjusted gender stratified models, Black men (aRR = .61, 95% CI [0.50, 0.75]) and Asian American men (aRR = .61, 95% CI [0.50, 0.75]) were at lower risk of smoking compared to White men. Black women were the only to remain statistically significant for decreased risk of smoking in fully adjusted gender stratified models (aRR = 0.78, 95 % CI [0.65, 0.95]). CONCLUSIONS: Among sexual minorities, Black and Asian American individuals consistently were at decreased risk of current smoking compared to their white peers. Future research should seek to understand the mechanisms that contribute to decreased smoking status among racial sexual minorities.

Siconolfi, D. E., Kapadia, F., Moeller, R. W., Eddy, J. A., Kupprat, S. A., Kingdon, M. J., & Halkitis, P. N. (2015). Body Dissatisfaction in a Diverse Sample of Young Men Who Have Sex With Men: The P18 Cohort Study. Arch Sex Behav. doi:10.1007/s10508-015-0592-3

Young men who have sex with men (YMSM) may be at greater risk for body dissatisfaction, compared to their heterosexual peers. However, differences within YMSM populations are understudied, precluding the identification of YMSM who are at greatest risk. This study examined body dissatisfaction in a racially/ethnically diverse sample of YMSM ages 18-19 in New York City. Using cross-sectional data from the baseline visit of a longitudinal cohort study of YMSM (N = 591), body dissatisfaction was assessed using the Male Body Attitudes Scale. Three outcomes were modeled using linear regression: (1) overall body dissatisfaction, (2) muscularity dissatisfaction, and (3) body fat dissatisfaction. Covariates in the models included race/ethnicity, sexual orientation, BMI, gay community affiliation, and internalized homonegativity. White YMSM experienced greater body dissatisfaction across the three models. Internalized homonegativity was a statistically significant predictor of dissatisfaction across the three models, though its association with body dissatisfaction was relatively small. The findings point to future avenues of research, particularly qualitative research to explore demographic and cultural nuances in body attitudes among YMSM.

Stack, C., Oldenburg, C., Mimiaga, M., Elsesser, S. A., Krakower, D., Novak, D. S., . . . Mayer, K. H. (2016). Sexual Behavior Patterns and PrEP Dosing Preferences in a Large Sample of North American Men Who Have Sex With Men. J Acquir Immune Defic Syndr, 71(1), 94-101. doi:10.1097/qai.0000000000000816

INTRODUCTION: Pre-exposure prophylaxis (PrEP), taken as a single daily coformulated pill containing tenofovir -emtricitabine, is a promising intervention to reduce the likelihood of HIV acquisition in at-risk individuals, including men who have sex with men. Little is known about the acceptability of less than daily, intermittent PrEP regimens. METHODS: We conducted an online survey of North American men who have sex with men to characterize their sexual frequency and planning behaviors and correlate these with PrEP dosing preferences. RESULTS: Of the 3217 respondents who completed the survey, 46% reported engaging in unplanned condomless anal intercourse (CAI) at least once in previous 3 months and 8% reported engaging in CAI more than once per week. In multivariable analysis, reporting unplanned CAI was associated with lower educational level, identifying as homosexual/gay as compared with bisexual, being in a monogamous relationship, having a higher self-perceived risk of HIV acquisition, reporting higher income, engaging in CAI more than five times in the last 3 months, and not having visited a health care provider in the previous year. Frequent CAI (>1 time per week) was associated with being younger, identifying as homosexual/gay as compared with bisexual, being in a monogamous relationship, and having a higher self-perceived risk of HIV. Having only planned sex over the last 3 months was associated with a preference for event-based PrEP, whereas having frequent or unplanned CAI was associated with a preference for daily or time-driven PrEP regimens, respectively. CONCLUSION: Our findings suggest that preferences for different PrEP regimens are associated with the sexual frequency and planning behaviors of potential users.

Wirtz, A. L., Zelaya, C. E., Latkin, C., Stall, R., Peryshkina, A., Galai, N., . . . Beyrer, C. (2015). Alcohol Use and Associated Sexual and Substance Use Behaviors Among Men Who Have Sex with Men in Moscow, Russia. AIDS Behav. doi:10.1007/s10461-015-1066-2

Alcohol use is a public health problem in the Russian Federation. This study explored relationships between alcohol use and behavioral risks for HIV transmission among men who have sex with men (MSM) in Moscow, Russia. Alcohol use disorder identification test (AUDIT) scores for 1367 MSM participating in a cross-sectional survey and HIV testing were categorized to: “abstinence/low use”, “hazardous use”, “harmful use/dependency”. Multiple logistic regression models compared dependent variables for sexual and drug use behaviors across alcohol use strata. Hazardous and harmful/dependent alcohol use were significantly associated with high-risk sexual behaviors and drug use. Harmful use/dependency was associated with an increased odds of having more than five male sex partners (last 12 months; adjusted odds ratios-AOR 1.69; 95 % CI 1.25-2.27), inconsistent condom use during anal intercourse (AOR 2.19; 95 % CI 1.61-2.96) and, among those using recreational drugs, injection drug use (last month; AOR 4.38: 95 % CI 1.13-17.07) compared to abstinent/low-level users. Harmful/dependent use was marginally associated with HIV infection (AOR 1.48; 95 % CI 0.97-2.25). HIV prevention efforts for MSM in Moscow may benefit from addressing problem alcohol use to mitigate high-risk behaviors.

Wirtz, A. L., Zelaya, C. E., Peryshkina, A., McGowan, I., Cranston, R. D., Latkin, C., . . . Beyrer, C. (2015). Anal human papillomavirus and HIV: A cross-sectional study among men who have sex with men in Moscow, Russia, 2012-2013. Euro Surveill, 20(15)  

Anal human papillomavirus (HPV) is prevalent among men who have sex with men (MSM), but has not been studied in the Russian Federation. A cross-sectional survey and HPV genotyping were conducted among HIV seropositive (n=58) and seronegative MSM (n=65)in Moscow. Multivariable logistic regression was performed to identify correlates of infection with oncogenic HPV genotypes 16 and/or 18 (HPV 16/18). Forty per cent (49/124) of all MSM were infected with at least one anal HPV genotype, 31.5% (39/124) had HPV16/18,and 11.5% (14/121) had high-grade squamous intraepithelial lesions (HSIL). HPV 16/18 was more prevalent in HIV seropositive than seronegative men (24/58,41.4% vs 15/65, 23.1%; p=0.03). HIV infection was independently associated with HPV 16/18 (adjusted odds ratio (AOR): 5.08; 95% confidence intervals (CI):1.49-17.34, p=0.01), as was having 2-4 steady male sex partners in the last year (vs </= 1 partner; AOR: 6.99;95%CI: 1.94-25.24, p<0.01). History of prison/detention,migration to/within Russia and use of incompatible lubricants were marginally associated with HPV16/18 (p<0.10). Comprehensive prevention options are needed to address HIV and HPV infection among MSM in Russia and may benefit from inclusion of young men in piloted HPV vaccination programmes.

 Yang, C., Linas, B., Kirk, G., Bollinger, R., Chang, L., Chander, G., . . . Latkin, C. (2015). Feasibility and Acceptability of Smartphone-Based Ecological Momentary Assessment of Alcohol Use Among African American Men Who Have Sex With Men in Baltimore. JMIR Mhealth Uhealth, 3(2), e67. doi:10.2196/mhealth.4344

BACKGROUND: Alcohol use is a risk factor for the acquisition of human immunodeficiency virus (HIV) among African American men who have sex with men (MSM). Mobile phone-based ecological momentary assessments (EMA) could minimize bias due to retrospective recall and thus provide a better understanding of the social and structural context of alcohol use and its relationship with HIV-related risk behaviors in this population as well as other highly stigmatized populations. OBJECTIVE: We describe the study design and the implementation, feasibility, reactivity, and acceptability of an EMA study of alcohol use and HIV-related behaviors among African American MSM in Baltimore. METHODS: Participants were recruited through flyers and word-of-mouth in Baltimore from September 2013 to November 2014. Each participant was loaned an Android smartphone and instructed to respond to multiple prompts from the mobile app for 4 weeks. Data were collected through (1) random prompts delivered three times daily assessing participants’ location, activity, mood, and social context, (2) daily prompts capturing drinking and sex events occurring in the past 24 hours, and (3) event-contingent responses collecting participants’ self-reported episodes of drinking. RESULTS: A total of 16 participants enrolled in the study. The current analyses focused on 15 participants who completed at least 24 days of follow-up (mean follow-up time 29 days; range 24-35 days). Study participants (N=15) were a median 38 years of age (range 27-62 years) with low levels of income and educational attainment. Ten individuals self-reported living with HIV/AIDS, over half reported drinking alcohol at least 2-3 times a week, and a third reported binge drinking (ie, 6 or more drinks on one occasion) on a weekly basis. Based on the Alcohol Use Disorders Identification Test (AUDIT) score, nearly half were classified as hazardous drinkers (score 8-15) and a fifth were likely dependent (score >/=16). A total of 140 participant-initiated events were reported, and 75% of 1308 random prompts and 81% of 436 daily prompts delivered were answered. Of seven devices used during the study, five were reported lost by participants. We did not observe strong reactivity effects, and self-reported acceptability to study procedures was uniformly favorable. CONCLUSIONS: This study provides evidence to support the feasibility and acceptability of using EMA methods for collecting data on alcohol use among African American men who have sex with men living in urban settings. These data provide the basis for future studies of EMA-informed mHealth interventions to promote the reduction of substance use and HIV risk-taking behaviors among African American MSM living in urban settings.

 

2014

Althoff, K. N., Jacobson, L. P., Cranston, R. D., Detels, R., Phair, J. P., Li, X., & Margolick, J. B. (2014). Age, comorbidities, and AIDS predict a frailty phenotype in men who have sex with men. J Gerontol A Biol Sci Med Sci, 69(2), 189-198. doi: 10.1093/gerona/glt148

BACKGROUND: Adults aging with HIV infection are at risk for age-related comorbidities and syndromes, such as frailty. The objective of this study was to evaluate the expression and predictors of the frailty phenotype (FP) among HIV-infected (HIV+) and HIV-uninfected (HIV-) men who have sex with men. METHODS: A prospective, observational cohort study was nested in the Multicenter AIDS Cohort Study from October 2007-September 2011. FP conversion was defined as the onset of FP over two consecutive study visits. Adjusted odds ratios and 95% confidence intervals ([,]) for FP conversion were estimated using logistic regression models with generalized estimating equations. RESULTS: Of 10,571 completed study visits from 1,946 men who have sex with men, 12% and 9% were FP+ among HIV+ and HIV- men, respectively (p = .002). The proportion of FP+ visits increased with age regardless of HIV status, but was significantly greater in HIV+ compared to HIV- men aged 50-64 years. Of the 10,276 consecutive visit pairs contributed by participants, 5% (537) were classified as FP conversion, and 45% of the men with FP conversion had only one FP+ study visit. FP conversion was significantly associated with a history of AIDS (adjusted odds ratios = 2.26 [1.50, 3.39], but not with HIV+ alone (adjusted odds ratios = 1.26 [0.98, 1.64]). Among men who had one or more FP+ visits, 34% of HIV+ and 38% of HIV- men had less than two comorbidities. CONCLUSIONS: These findings suggest that expression of the FP can be measured in men who have sex with men with and without HIV infection and reflects multisystem dysfunction in this population; further investigations are needed to better understand clinical utility.

Bauermeister, J. A., Meanley, S., Hickok, A., Pingel, E., Vanhemert, W., & Loveluck, J. (2014). Sexuality-related work discrimination and its association with the health of sexual minority emerging and young adult men in the Detroit Metro Area. Sex Res Social Policy, 11(1), 1-10. doi: 10.1007/s13178-013-0139-0

Discrimination has been linked to negative health outcomes among minority populations. The increasing evidence regarding health disparities among sexual minorities has underscored the importance of addressing sexuality discrimination as a public health issue. We conducted a web-based survey between May and September of 2012 in order to obtain a diverse sample of young men who have sex with men (ages 18-29; N = 397; 83% gay; 49% Black, 27% White, 15% Latino) living in the Detroit Metro Area (Michigan, USA). Using multivariate regression models, we examined the association between overall health (self-rated health, days in prior month when their physical or mental health was not good, limited functionality) and experiences of sexuality-based work discrimination. Fifteen percent reported at least one experience of sexuality-based work discrimination in the prior year. Recent workplace discrimination was associated with poorer self-rated health, a greater number of days when health was not good, and more functional limitation. We discuss the importance of addressing sexuality-related discrimination as a public health problem and propose multilevel intervention strategies to address these discriminatory practices.

Bauermeister, J. A., Yeagley, E., Meanley, S., & Pingel, E. S. (2014). Sexting among young men who have sex with men: results from a national survey. J Adolesc Health, 54(5), 606-611. doi: 10.1016/j.jadohealth.2013.10.013

PURPOSE: We know little about the prevalence of sexting behavior among young men who have sex with men (YMSM) or its association with their sexual behaviors. METHODS: To address these gaps, we used data from an online study examining the partner-seeking behaviors of single YMSM (N = 1,502; ages 18-24 years) in the United States. Most participants (87.5%) reported sexting, with 75.7% of the sample reporting having sent and received a sext. RESULTS: Sexting was more frequent among sexually active YMSM, with YMSM who had sent and received a sext being more likely to report insertive anal intercourse, with and without condoms, than those who had not sexted. We found no association between sexting and receptive anal intercourse. CONCLUSIONS: Our findings suggest that sexting may vary by YMSM’s sexual roles. We discuss our findings with attention to their implications for sexual health promotion.

Berry, J. M., Jay, N., Cranston, R. D., Darragh, T. M., Holly, E. A., Welton, M. L., & Palefsky, J. M. (2014). Progression of anal high-grade squamous intraepithelial lesions to invasive anal cancer among HIV-infected men who have sex with men. Int J Cancer, 134(5), 1147-1155. doi: 10.1002/ijc.28431

The incidence of anal cancer is elevated in human immunodeficiency virus (HIV)-infected men-who-have-sex-with-men (MSM) compared to the general population. Anal high-grade squamous intraepithelial lesions (HSIL) are common in HIV-infected MSM and the presumed precursors to anal squamous cell cancer; however, direct progression of HSIL to anal cancer has not been previously demonstrated. The medical records were reviewed of 138 HIV-infected MSM followed up at the University of California, San Francisco, who developed anal canal or perianal squamous cancer between 1997 and 2011. Men were followed up regularly with digital anorectal examination (DARE), high-resolution anoscopy (HRA) and HRA-guided biopsy. Although treatment for HSIL and follow-up were recommended, not all were treated and some were lost to follow-up. Prevalent cancer was found in 66 men. Seventy-two HIV-infected MSM developed anal cancer while under observation. In 27 men, anal cancer developed at a previously biopsied site of HSIL. An additional 45 men were not analyzed in this analysis due to inadequate documentation of HSIL in relation to cancer location. Of the 27 men with documented progression to cancer at the site of biopsy-proven HSIL, 20 men progressed from prevalent HSIL identified when first examined and seven men from incident HSIL. Prevalent HSIL progressed to cancer over an average of 57 months compared to 64 months for incident HSIL. Most men were asymptomatic, and cancers were detected by DARE. Anal HSIL has clear potential to progress to anal cancer in HIV-infected MSM. Early diagnosis is facilitated by careful follow-up. Carefully controlled studies evaluating efficacy of screening for and treatment of HSIL to prevent anal cancer are needed.

Blosnich, J. R., Farmer, G. W., Lee, J. G., Silenzio, V. M., & Bowen, D. J. (2014). Health inequalities among sexual minority adults: evidence from ten U.S. states, 2010. Am J Prev Med, 46(4), 337-349. doi: 10.1016/j.amepre.2013.11.010

BACKGROUND: Improving the health of lesbian, gay, and bisexual (LGB) individuals is a Healthy People 2020 goal; however, the IOM highlighted the paucity of information currently available about LGB populations. PURPOSE: To compare health indicators by gender and sexual orientation statuses. METHODS: Data are from Behavioral Risk Factor Surveillance System surveys conducted January-December of 2010 with population-based samples of non-institutionalized U.S. adults aged over 18 years (N=93,414) in ten states that asked about respondents’ sexual orientation (response rates=41.1%-65.6%). Analyses were stratified by gender and sexual orientation to compare indicators of mental health, physical health, risk behaviors, preventive health behaviors, screening tests, health care utilization, and medical diagnoses. Analyses were conducted in March 2013. RESULTS: Overall, 2.4% (95% CI=2.2, 2.7) of the sample identified as LGB. All sexual minority groups were more likely to be current smokers than their heterosexual peers. Compared with heterosexual women, lesbian women had more than 30% decreased odds of having an annual routine physical exam, and bisexual women had more than 2.5 times the odds of not seeking medical care owing to cost. Compared with heterosexual men, gay men were less likely to be overweight or obese, and bisexual men were twice as likely to report a lifetime asthma diagnosis. CONCLUSIONS: This study represents one of the largest samples of LGB adults and finds important health inequalities, including that bisexual women bear particularly high burdens of health disparities. Further work is needed to identify causes of and intervention for these disparities.

Blosnich, J. R., Mays, V. M., & Cochran, S. D. (2014). Suicidality among veterans: implications of sexual minority status. Am J Public Health, 104 Suppl 4, S535-537. doi: 10.2105/ajph.2014.302100

Using the California Quality of Life surveys, we examined suicidal ideation and attempts in 129 lesbian, gay, and bisexual (LGB) veterans and in 315 heterosexual veterans in 2008-2009 and 2012-2013. Although there were no significant differences in the past 12-month suicidal ideation and lifetime attempts, LGB veterans had higher odds of lifetime suicidal ideation than heterosexual veterans (adjusted odds ratio = 3.00; 95% confidence interval = 1.38, 6.53). Suicide assessment and prevention efforts in LGB veterans could benefit from a life-course perspective regarding suicide risk.

Bruce, D., Stall, R., Fata, A., & Campbell, R. T. (2014). Modeling minority stress effects on homelessness and health disparities among young men who have sex with men. J Urban Health, 91(3), 568-580. doi: 10.1007/s11524-014-9876-5

Sexual minority youth are more likely to experience homelessness, and homeless sexual minority youth report greater risk for mental health and substance abuse symptoms than homeless heterosexual youth, yet few studies have assessed determinants that help explain the disparities. Minority stress theory proposes that physical and mental health disparities among sexual minority populations may be explained by the stress produced by living in heterosexist social environments characterized by stigma and discrimination directed toward sexual minority persons. We used data from a sample of 200 young men who have sex with men (YMSM) (38 % African American, 26.5 % Latino/Hispanic, 23.5 % White, 12 % multiracial/other) to develop an exploratory path model measuring the effects of experience and internalization of sexual orientation stigma on depression and substance use via being kicked out of home due to sexual orientation and current homelessness. Direct significant paths were found from experience of sexual orientation-related stigma to internalization of sexual orientation-related stigma, having been kicked out of one’s home, experiencing homelessness during the past year, and major depressive symptoms during the past week. Having been kicked out of one’s home had a direct significant effect on experiencing homelessness during the past 12 months and on daily marijuana use. Internalization of sexual orientation-related stigma and experiencing homelessness during the past 12 months partially mediated the direct effect of experience of sexual orientation-related stigma on major depressive symptoms. Our empirical testing of the effects of minority stress on health of YMSM advances minority stress theory as a framework for investigating health disparities among this population.

Burton, C. M., Marshal, M. P., & Chisolm, D. J. (2014). School absenteeism and mental health among sexual minority youth and heterosexual youth. J Sch Psychol, 52(1), 37-47. doi: 10.1016/j.jsp.2013.12.001

Adolescent school absenteeism is associated with negative outcomes such as conduct disorders, substance abuse, and dropping out of school. Mental health factors, such as depression and anxiety, have been found to be associated with increased absenteeism from school. Sexual minority youth (youth who are attracted to the same sex or endorse a gay, lesbian, or bisexual identity) are a group at risk for increased absenteeism due to fear, avoidance, and higher rates of depression and anxiety than their heterosexual peers. The present study used longitudinal data to compare sexual minority youth and heterosexual youth on excused and unexcused absences from school and to evaluate differences in the relations between depression and anxiety symptoms and school absences among sexual minority youth and heterosexual youth. A total of 108 14- to 19-years-old adolescents (71% female and 26% sexual minority) completed self-report measures of excused and unexcused absences and depression and anxiety symptoms. Compared to heterosexual youth, sexual minority youth reported more excused and unexcused absences and more depression and anxiety symptoms. Sexual minority status significantly moderated the effects of depression and anxiety symptoms on unexcused absences such that depression and anxiety symptoms were stronger predictors of unexcused absences for sexual minority youth than for heterosexual youth. The results demonstrate that sexual minority status and mental health are important factors to consider when assessing school absenteeism and when developing interventions to prevent or reduce school absenteeism among adolescents.

Carballo-Dieguez, A., Giguere, R., Dolezal, C., Bauermeister, J., Leu, C. S., Valladares, J., . . . McGowan, I. (2014). Adherence to rectal gel use among mainly ethnic minority young men who have sex with men during a 3-month placebo gel trial: implications for microbicide research. AIDS Behav, 18(9), 1726-1733. doi: 10.1007/s10461-014-0768-1

To study adherence to product use prior to a Phase I microbicide trial, we recruited young men who have sex with men (YMSM) with a history of unprotected receptive anal intercourse (RAI) and provided them with 40 rectal applicators containing a placebo gel to use prior to RAI during a 12-week period. Ninety-five YMSM completed the trial. Based on a Computer Assisted Self Interview, 83 participants had receptive anal intercourse (RAI) (Median 12 occasions) using gel on 82.4 % of occasions (SD 26.7; 0-100). Based on an interactive voice response system, 88 participants had RAI (Median 10 occasions) using gel on 87.9 % of occasions (SD 20.0; 20-100). By applicator counts the median gel use was 12. Participants showed high adherence to gel use. Those who did not use the product consistently (n = 40) adduced not having it with them (85 %), forgetting to use it (48 %), not wanting to use it (13 %), partner refusal (10 %) and gel messiness (10 %).

Carballo-Dieguez, A., Giguere, R., Dolezal, C., Bauermeister, J., Leu, C. S., Valladares, J., . . . McGowan, I. (2014). Rectal-specific microbicide applicator: evaluation and comparison with a vaginal applicator used rectally. AIDS Behav, 18(9), 1734-1745. doi: 10.1007/s10461-014-0793-0

An applicator designed for rectal delivery of microbicides was tested for acceptability by 95 young men who have sex with men, who self-administered 4 mL of placebo gel prior to receptive anal intercourse over 90 days. Subsequently, 24 of the participants self-administered rectally 4 mL of tenofovir or placebo gel over 7 days using a vaginal applicator, and compared both applicators on a Likert scale of 1-10, with 10 the highest rating. Participants reported high likelihood to use either applicator in the future (mean scores 9.3 and 8.8 respectively, p = ns). Those who tested both liked the vaginal applicator significantly more than the rectal applicator (7.8 vs. 5.2, p = 0.003). Improvements in portability, conspicuousness, aesthetics, tip comfort, product assembly and packaging were suggested for both. This rectal-specific applicator was not superior to a vaginal applicator. While likelihood of future use is reportedly high, factors that decrease acceptability may erode product use over time in clinical trials. Further attention is needed to develop user-friendly, quick-acting rectal microbicide delivery systems.

Carrico, A. W., Shoptaw, S., Cox, C., Stall, R., Li, X., Ostrow, D. G., . . . Plankey, M. W. (2014). Stimulant use and progression to AIDS or mortality after the initiation of highly active antiretroviral therapy. J Acquir Immune Defic Syndr, 67(5), 508-513. doi: 10.1097/qai.0000000000000364

BACKGROUND: HIV-positive persons who use stimulants (eg, methamphetamine) experience profound health disparities, but it remains unclear whether these persist after highly active antiretroviral therapy (HAART) initiation. Conducted within the Multicenter AIDS Cohort Study, this investigation examined whether stimulant use is associated with progression to AIDS or all-cause mortality after the initiation of HAART. METHODS: Using marginal structural modeling, the cumulative proportion of visits where any stimulant use was reported (ie, 0%, 1%-49%, 50%-99%, and 100%) was examined as a time-varying predictor of (1) all-cause mortality and (2) AIDS or all-cause mortality. RESULTS: Among the 1313 men who have sex with men (MSM) who initiated HAART, findings showed no significant association of any level of stimulant use with all-cause mortality. A competing risk analysis indicated that no level of stimulant use was associated with increased AIDS-related or non-AIDS mortality separately. Among the 648 participants without AIDS at HAART initiation, a secondary analysis indicated that stimulant use at 50% or more of study visits was associated with a 1.5-fold increase in the odds of progression to AIDS or all-cause mortality (adjusted odds ratio = 1.54; 95% confidence interval: 1.02 to 2.33; P < 0.05). CONCLUSIONS: HIV-positive stimulant-using MSM receiving HAART seem to face no greater overall risks for all-cause, AIDS-related, or non-AIDS mortality compared with nonusers. However, men without AIDS at HAART initiation who more frequently reported stimulant use demonstrated modestly increased odds of progression to AIDS or all-cause mortality. Comprehensive approaches are needed to optimize the effectiveness of HAART with stimulant-using MSM.

Cheung, D. H., Suharlim, C., Guadamuz, T. E., Lim, S. H., Koe, S., & Wei, C. (2014). Earlier anal sexarche and co-occurring sexual risk are associated with current HIV-related risk behaviors among an online sample of men who have sex with men in Asia. AIDS Behav, 18(12), 2423-2431. doi: 10.1007/s10461-014-0821-0

Studies of heterosexual populations across the globe and men who have sex with men (MSM) in a few developed countries showed that earlier sexual debut (sexarche) was associated with higher levels of co-occurring and subsequent HIV risk behaviors. We examined the relationships between earlier anal sexarche, unprotected earlier anal sexarche and current HIV risks among MSM from Asia. A cross-sectional online survey was conducted among MSM (N = 10,826) in Asia in 2010. Bivariate and multivariable logistic regressions were used to identify co-occurring (i.e., sexual experiences during sexarche) and current HIV-related risk factors (i.e., past 6 months) associated with earlier anal sexarche (before the age of 18) and unprotected earlier anal sexarche, respectively. Earlier anal sexarche was significantly associated with lack of condom use, being anal receptive or both receptive and insertive, and having a partner who were older during sexarche. It was also associated with current HIV-related risk behaviors including having multiple male sexual partners, having been paid for sex, and increased frequencies of recreational drug use. Unprotected earlier anal sexarche was significantly associated with inconsistent condom use in the past the 6 months. Improved and culturally sensitive sex education at schools should be included in national and regional HIV/AIDS prevention programming and policies in Asia. Such sex education programs should incorporate curriculum that address sexuality, sexual orientation, and sexual behaviors beyond those related to reproductive health.

Coulter, R. W., Kenst, K. S., Bowen, D. J., & Scout. (2014). Coulter et al. respond. Am J Public Health, 104(7), e7-8. doi: 10.2105/ajph.2014.302028

Coulter, R. W., Kenst, K. S., Bowen, D. J., & Scout. (2014). Research funded by the National Institutes of Health on the health of lesbian, gay, bisexual, and transgender populations. Am J Public Health, 104(2), e105-112. doi: 10.2105/ajph.2013.301501

OBJECTIVES: We examined the proportion of studies funded by the National Institutes of Health (NIH) that focused on lesbian, gay, bisexual, and transgender (LGBT) populations, along with investigated health topics. METHODS: We used the NIH RePORTER system to search for LGBT-related terms in NIH-funded research from 1989 through 2011. We coded abstracts for LGBT inclusion, subpopulations studied, health foci, and whether studies involved interventions. RESULTS: NIH funded 628 studies concerning LGBT health. Excluding projects about HIV/AIDS and other sexual health matters, only 0.1% (n = 113) of all NIH-funded studies concerned LGBT health. Among the LGBT-related projects, 86.1% studied sexual minority men, 13.5% studied sexual minority women, and 6.8% studied transgender populations. Overall, 79.1% of LGBT-related projects focused on HIV/AIDS and substantially fewer on illicit drug use (30.9%), mental health (23.2%), other sexual health matters (16.4%), and alcohol use (12.9%). Only 202 studies examined LGBT health-related interventions. Over time, the number of LGBT-related projects per year increased. CONCLUSIONS: The lack of NIH-funded research about LGBT health contributes to the perpetuation of health inequities. Here we recommend ways for NIH to stimulate LGBT-related research.

Cranston, R. D. (2014). Young gay men and the quadrivalent human papillomavirus vaccine–much to gain (and lose). J Infect Dis, 209(5), 635-638. doi: 10.1093/infdis/jit627

Dermody, S. S., Marshal, M. P., Cheong, J., Burton, C., Hughes, T., Aranda, F., & Friedman, M. S. (2014). Longitudinal disparities of hazardous drinking between sexual minority and heterosexual individuals from adolescence to young adulthood. J Youth Adolesc, 43(1), 30-39. doi: 10.1007/s10964-013-9905-9

Sexual minority (lesbian and gay, bisexual, mostly heterosexual) individuals are at an increased risk for hazardous drinking than heterosexual individuals, but little is known about the nature of the disparities as adolescents reach adulthood. We used four waves of a nationally representative data set, the National Longitudinal Study of Adolescent Health (Add Health), to examine disparities of hazardous drinking outcomes between sexual minority and heterosexual men and women from adolescence to young adulthood. Participants were 14-18 years old at the first assessment (N = 12,379; 53 % female) and 27-31 years old at the fourth assessment. At the fourth assessment, 13 % self-identified as sexual minority individuals, 16 % were Hispanic, and 36 % were of minority race, including primarily African Americans (60 %) and Asian Americans (18 %). There were clear hazardous drinking disparities between sexual minority individuals and heterosexual individuals over time. During adolescence, sexual minority individuals, particularly females, reported higher levels of hazardous drinking. As study participants reached adulthood, the magnitude of the hazardous drinking disparities increased among sexual minorities, sexual minority men in particular. Additional research is needed to better understand the developmental mechanisms that underlie the emerging sexual orientation related disparities of hazardous drinking in young adulthood.

Friedman, M. R., Dodge, B., Schick, V., Herbenick, D., Hubach, R., Bowling, J., . . . Reece, M. (2014). From bias to bisexual health disparities: Attitudes toward bisexual mean and women in the United States. LGBT Health, 1(4), 309-318

PURPOSE: A newly emergent literature suggest that bisexual men and women face profound health disparities in comparison to both heterosexual and homosexual individuals. Additionally, bisexual individuals often experience prejudice, stigma, and discrimination from both gay/lesbian and straight communities, termed “biphobia.” However, only limited research exists that empirically tests the extent and predictors of this double discrimination. The Bisexualities: Indiana Attitudes Survey (BIAS) was developed to test associations between biphobia and sexual identity. METHODS: Using standard techniques, we developed and administered a scale to a purposive online sample of adults from a wide range of social networking websites. We conducted exploratory factor analysis to refine scales assessing attitudes toward bisexual men and bisexual women, respectively. Using generalized linear modeling, we assessed relationships between BIAS scores and sexual identity, adjusting for covariates. RESULTS: Two separately gendered scales were developed, administered, and refined: BIAS-m (n=645), focusing on attitudes toward bisexual men; and BIAS-f (n=631), focusing on attitudes toward bisexual women. Across scales, sexual identity significantly predicted response variance. Lesbian/gay respondents had lower levels of bi-negative attitudes than their heterosexual counterparts (all p-values <.05); bisexual respondents had lower levels of bi-negative attitudes than their straight counterparts (all p-values <.001); and bisexual respondents had lower levels of bi-negative attitudes than their lesbian/gay counterparts (all p-values <.05). Within racial/ethnic minority respondents, biracial/multiracial status was associated with lower bi-negativity scores (all p-values <.05). CONCLUSION: This study provides important quantitative support for theories related to biphobia and double discrimination. Our findings provide strong evidence for understanding how stereotypes and stigma may lead to dramatic disparities in depression, anxiety, stress, and other health outcomes among bisexual individuals in comparison to their heterosexual and homosexual counterparts. Our results yield valuable data for informing social awareness and intervention efforts that aim to decrease bi-negative attitudes within both straight and gay/lesbian communities, with the ultimate goal of alleviating health disparities among bisexual men and women.

Friedman, M. R., Kurtz, S. P., Buttram, M. E., Wei, C., Silvestre, A. J., & Stall, R. (2014). HIV risk among substance-using men who have sex with men and women (MSMW): findings from South Florida. AIDS Behav, 18(1), 111-119. doi: 10.1007/s10461-013-0495-z

Compared with men who have sex with men only (MSMO), men who have sex with men and women (MSMW) consistently report higher rates of two HIV risk behaviors: transactional sex (TS) and concurrent substance use and sex (CSS). Within MSMW, little is known about how synergistic epidemics (“syndemics”) affect TS and CSS. Using a sample of substance-using MSM (n = 515) in South Florida, we compared TS and CSS among MSMO and MSMW; examined whether, within MSMW (n = 86), TS and CSS predict unprotected anal intercourse with partners of serodiscordant/unknown HIV status (SU-UAI); and tested whether syndemics predict TS and CSS. MSMW reported higher rates of engaging in both TS and CSS (AOR = 1.7; 95 % CI 1.0-3.0). Within MSMW, engagement in both TS and CSS predicted SU-UAI (AOR = 3.3; 95 % CI 1.2-9.6); and syndemics predicted TS and CSS involvement (p < 0.01). Substance-using MSMW may benefit from interventions targeting TS, CSS, and background syndemics.

Friedman, M. R., Stall, R., Silvestre, A. J., Mustanski, B., Shoptaw, S., Surkan, P. J., . . . Plankey, M. W. (2014). Stuck in the middle: longitudinal HIV-related health disparities among men who have sex with men and women. J Acquir Immune Defic Syndr, 66(2), 213-220. doi: 10.1097/qai.0000000000000143

INTRODUCTION: Men who have sex with men and women (MSMW) have been shown in cross-sectional studies to suffer HIV-related health disparities above and beyond those found among men who have sex with men only (MSMO). We conducted a secondary data analysis over a 7-year time frame of participants in the Multicenter AIDS Cohort Study, a long-standing prospective cohort study, to examine whether MSMW had persistently higher rates of depression symptoms, polydrug use, and (among HIV-positive men who have sex with men) HIV viral load levels compared with MSMO. METHODS: Men were behaviorally defined as bisexual if they reported sexual activity with at least 1 male and 1 female partner between study waves 38 and 50. We used generalized mixed modeling with repeated measures to test differences in CES-D score, polydrug use, and viral load between sexually active MSMO (n = 1514) and MSMW (n = 111), adjusting for age, income, race/ethnicity, and recent seroconversion. RESULTS: MSMW were significantly more likely than MSMO to have higher CES-D scores, polydrug use, and viral load levels (all P < 0.01). Outcome trajectories did not differ significantly over time between these groups. Black and Hispanic HIV-positive MSMW had higher viral load levels relative to white HIV-positive MSMW (P < 0.01). DISCUSSION: Compared with MSMO, MSMW in the Multicenter AIDS Cohort Study suffer from profound and persistent HIV-related health disparities across biological, behavioral, and psychosocial domains. Further qualitative and quantitative research contextualizing the pathways underlying these disparities is recommended for intervention development targeting MSMW at risk for HIV acquisition and transmission.

Friedman, M. R., Wei, C., Klem, M. L., Silvestre, A. J., Markovic, N., & Stall, R. (2014). HIV infection and sexual risk among men who have sex with men and women (MSMW): a systematic review and meta-analysis. PLoS One, 9(1), e87139. doi: 10.1371/journal.pone.0087139

OBJECTIVES: To estimate the number of men who have sex with men and women who are HIV-positive in the United States, and to compare HIV prevalence rates between men who have sex with men and women, men who have sex with men only, and men who have sex with women exclusively. METHODS: Following PRISMA guidelines, we conducted a systematic review and meta-analysis of reports referencing HIV prevalence and men who have sex with men and women. We searched PubMed and Ovid PsycINFO for peer-reviewed, U.S.-based articles reporting on HIV prevalence among men who have sex with men and women. We conducted event rate, effect size, moderation and sensitivity analyses. RESULTS: We estimate that 1.0% of U.S. males are bisexually-behaving, and that 121,800 bisexually-behaving men are HIV-positive. Men who have sex with men and women are less than half as likely to be HIV-positive as men who have sex with men only (16.9% vs. 33.3%; OR = 0.41, 95% CI: 0.31, 0.54), but more than five times as likely to be HIV-positive as men who have sex with women exclusively (18.3% vs. 3.5%; OR = 5.71, 95% CI: 3.47, 9.39). They are less likely to engage in unprotected receptive anal intercourse than men who have sex with men only (15.9% vs. 35.0%; OR = 0.36, 95% CI: 0.28, 0.46). Men who have sex with men and women in samples with high racial/ethnic minority proportions had significantly higher HIV prevalence than their counterparts in low racial/ethnic minority samples. CONCLUSIONS: This represents the first meta-analysis of HIV prevalence in the U.S. between men who have sex with men and women and men who have sex with men only. Data collection, research, and HIV prevention and care delivery specifically tailored to men who have sex with men and women are necessary to better quantify and ameliorate this population’s HIV burden.

Frye, V., Egan, J. E., Van Tieu, H., Cerda, M., Ompad, D., & Koblin, B. A. (2014). “I didn’t think I could get out of the fucking park.” Gay men’s retrospective accounts of neighborhood space, emerging sexuality and migrations. Soc Sci Med, 104, 6-14. doi: 10.1016/j.socscimed.2013.12.002

Young, African American and Latino gay, bisexual and other men who have sex with men (MSM) are disproportionately represented among new HIV cases according to the most recent national surveillance statistics. Analysts have noted that these racial/ethnic disparities in HIV among MSM exist within the wider context of sexual, mental and physical health disparities between MSM and heterosexuals. The intercorrelation of these adverse health outcomes among MSM, termed syndemics, has been theorized to be socially produced by a heterosexist social system that marginalizes lesbian, gay, bisexual, MSM and other sexual minorities. African American and Latino MSM experience overlapping systems of oppression that may increase their risk of experiencing syndemic health outcomes. In this paper, using data from twenty in-depth qualitative interviews with MSM living in four New York City (NYC) neighborhoods, we present accounts of neighborhood space, examining how space can both physically constitute and reinforce social systems of stratification and oppression, which in turn produce social disparities in sexual health outcomes. By analyzing accounts of emerging sexuality in neighborhood space, i.e. across time and space, we identify pathways to risk and contribute to our understanding of how neighborhood space is experienced by gay men, adding to our ability to support young men as they emerge in place and to shape the social topography of urban areas.

Guadamuz, T. E., McCarthy, K., Wimonsate, W., Thienkrua, W., Varangrat, A., Chaikummao, S., . . . van Griensven, F. (2014). Psychosocial health conditions and HIV prevalence and incidence in a cohort of men who have sex with men in Bangkok, Thailand: evidence of a syndemic effect. AIDS Behav, 18(11), 2089-2096. doi: 10.1007/s10461-014-0826-8

Men who have sex with men (MSM) in Bangkok may experience multiple psychosocial health conditions, such as substance use, suicidality, and a history of sexual abuse. These factors may contribute to HIV vulnerability in a syndemic way. A syndemic is defined as a number of synergistically interacting health conditions producing excess disease in a population. The objective of this study is to examine whether psychosocial health conditions among MSM have a syndemic association with HIV prevalence and HIV incidence. To do this, we evaluated psychosocial health conditions and their associations with unprotected sex, HIV prevalence and HIV incidence in a cohort of Thai MSM (N = 1,292). There was a positive and significant association between the number of psychosocial health conditions and increased levels of unprotected sex and HIV prevalence at study baseline. The number of psychosocial health conditions at baseline was also associated with increased HIV incidence during follow-up (no conditions, HIV incidence = 15.3 %; one to three conditions, 23.7 %; four to five conditions, 33.2 %). The number of psychosocial health conditions was positively associated with HIV risk behavior and HIV prevalence and incidence. Prevention efforts among MSM need to address the existence of multiple psychosocial health conditions and their synergy to effectively decrease the spread of HIV infection.

Han, L., Bien, C. H., Wei, C., Muessig, K. E., Yang, M., Liu, F., . . . Tucker, J. D. (2014). HIV self-testing among online MSM in China: implications for expanding HIV testing among key populations. J Acquir Immune Defic Syndr, 67(2), 216-221. doi: 10.1097/qai.0000000000000278

HIV self-testing offers an alternative to facility-based testing that could expand HIV testing among men who have sex with men (MSM). We organized an online survey of MSM in China to better understand the frequency and correlates of HIV self-testing. A total of 1342 individuals completed the survey. About 20.3% of MSM reported previous HIV self-testing. Self-testing was correlated with being married, having 6 or greater male anal sex partners in the past 3 months, and having HIV tested within 12 months in the multivariable analysis. Our study suggests that HIV self-testing may be able to reach subgroups of high-risk MSM and enable more frequent HIV testing.

Herrick, A., Stall, R., Egan, J., Schrager, S., & Kipke, M. (2014). Pathways towards risk: syndemic conditions mediate the effect of adversity on HIV risk behaviors among young men who have sex with men (YMSM). J Urban Health, 91(5), 969-982. doi: 10.1007/s11524-014-9896-1

Research shows that young men who have sex with men (YMSM) engage in higher rates of health risk behaviors and experience higher rates of negative health outcomes than their peers. The purpose of this study is to determine if the effects of adversity on HIV risk are mediated by syndemics (co-occurring health problems). Participants were 470 ethnically diverse YMSM ages 18 to 24 recruited between 2005 and 2006 and surveyed every 6 months for 24 months. Regression analyses examined the impact of adversity on syndemics (emotional distress, substance use, and problematic alcohol use) and the effects of both adversity and syndemics on HIV risk behaviors over time. Gay-related discrimination and victimization-among other adversity variables-were significantly associated with syndemics and condomless sex (CS). Syndemics mediated the effects of adversity on CS in all models. Adverse events impact HIV risk taking among YMSM through syndemics. These findings suggest that prevention programs aimed at reducing adversity may reduce both the synergistic effect of multiple psychosocial health problems and HIV risk taking.

Herrick, A. L., Egan, J. E., Coulter, R. W., Friedman, M. R., & Stall, R. (2014). Raising sexual minority youths’ health levels by incorporating resiliencies into health promotion efforts. Am J Public Health, 104(2), 206-210. doi: 10.2105/ajph.2013.301546

Myriad health inequities that sexual minority youths (SMYs) experience have been documented over the past several decades. Evidence demonstrates that these are not a result of intrinsic characteristics; rather, they result from high levels of adversity that SMYs experience. Despite the pervasive marginalization that SMYs face, there is also evidence of great resilience within this population. It seems likely that if a culture of marginalization produces health inequities in SMYs, a culture of acceptance and integration can work to produce resiliencies. We have described how promoting forms of acceptance and integration could work to promote resilient SMYs despite an overarching culture of marginalization. Building on SMYs’ resiliencies may potentiate the effectiveness of health promotion interventions to reduce health disparities within this population.

Herrick, A. L., Stall, R., Goldhammer, H., Egan, J. E., & Mayer, K. H. (2014). Resilience as a research framework and as a cornerstone of prevention research for gay and bisexual men: theory and evidence. AIDS Behav, 18(1), 1-9. doi: 10.1007/s10461-012-0384-x

This commentary presents the content and results of a recent symposium held to discuss how resiliencies among gay and bisexual men, and other men who have sex with men, could inform HIV prevention interventions. We outline the argument for including resiliencies in prevention work and present a critique of the deficit-based approached to public health research as it applies to this line of inquiry. The commentary makes the case that HIV prevention work would be more efficacious if it were designed to incorporate naturally occurring resiliencies that manifest among gay male communities rather than primarily using interventions that address vulnerabilities among men who continue to reside in high risk contexts. The commentary concludes by listing a set of resiliency variables and constructs proposed at the meeting that could be tested in theoretically-based investigations to raise resiliencies among gay and bisexual men thereby lowering HIV risks in this population.

Kauth, M. R., Shipherd, J. C., Lindsay, J., Blosnich, J. R., Brown, G. R., & Jones, K. T. (2014). Access to care for transgender veterans in the Veterans Health Administration: 2006-2013. Am J Public Health, 104 Suppl 4, S532-534. doi: 10.2105/ajph.2014.302086

A 2011 Veterans Health Administration directive mandated medically necessary care for transgender veterans. Internal education efforts informed staff of the directive and promoted greater access to care. For fiscal years 2006 through 2013, we identified 2662 unique individuals with International Classification of Diseases, Ninth Revision diagnoses related to transgender status in Veterans Health Administration medical records, with 40% of new cases in the 2 years following the directive. A bottom-up push for services by veterans and top-down education likely worked synergistically to speed implementation of the new policy and increase access to care.

Lee, J. G., Agnew-Brune, C. B., Clapp, J. A., & Blosnich, J. R. (2014). Out smoking on the big screen: tobacco use in LGBT movies, 2000-2011. Tob Control, 23(e2), e156-158. doi: 10.1136/tobaccocontrol-2013-051288

OBJECTIVE: Lesbian, gay, bisexual and transgender (LGBT) people have significantly higher smoking prevalence than heterosexual people in the U.S.A. The reasons for this disparity remain unclear. Tobacco use in movies has a substantial influence on tobacco use behaviours, particularly among youth. Yet, no research has examined tobacco use in movies for LGBT audiences or containing LGBT characters. METHODS: We identified 81 U.S. movies from 2000 to 2011 with a theatre release and with LGBT themes or characters. We then selected a random sample of these movies (n=45) for quantitative content analysis to examine the proportion of movies with depictions of tobacco use and the number of occurrences of tobacco use. RESULTS: Tobacco use was depicted in 87% (95% CI 80% to 94%) of movies with an average of four occurrences of tobacco use per hour (95% CI 3 to 5). Only 15% (95% CI 8% to 23%) of movies and 3% of all depictions of tobacco use conveyed any harms of tobacco use. CONCLUSIONS: Viewers of movies with LGBT themes or characters are exposed, on average, to one depiction of tobacco use for every 15 min of movie run-time. As a major component of the entertainment media environment, movies may contribute to smoking among LGBT people.

Lytle, M. C., De Luca, S. M., & Blosnich, J. R. (2014). The influence of intersecting identities on self-harm, suicidal behaviors, and depression among lesbian, gay, and bisexual individuals. Suicide Life Threat Behav, 44(4), 384-391

Individuals with lesbian, gay, and bisexual (LGB) identities have higher prevalence of self-directed violence, but very little is known about racial/ethnic differences between LGB populations. This study aimed to examine racial/ethnic differences in self-harm, suicidal ideation, suicide attempt, and depression among LGB and heterosexual emerging adults. Data are compiled from the Fall 2008 and Spring 2009 National College Health Assessment and limited to respondents within emerging adulthood (ages 18-24) who indicated their sexual orientation and racial/ethnic identities (n = 89,199). Within each racial/ethnic group, LGB individuals were significantly more likely to report self-harm, suicidal ideation, suicide attempt, and depression than non-LGB individuals.

Matthews, D. D., Blosnich, J. R., Farmer, G. W., & Adams, B. J. (2014). Operational Definitions of Sexual Orientation and Estimates of Adolescent Health Risk Behaviors. LGBT Health, 1(1), 42-49

PURPOSE: Increasing attention to the health of lesbian, gay, and bisexual (LGB) populations comes with requisite circumspection about measuring sexual orientation in surveys. However, operationalizing these variables also requires considerable thought. This research sought to document the consequences of different operational definitions of sexual orientation by examining variation in health risk behaviors. METHODS: Using Massachusetts Youth Risk Behavior Survey data, we examined how operational definitions of sexual behavior and sexual identity influenced differences among three health behaviors known to disparately affect LGB populations: smoking, suicide risk, and methamphetamine use. Sexual behavior and sexual identity were also examined together to explore if they captured unique sources of variability in behavior. RESULTS: Estimates of health disparities changed as a result of using either sexual behavior or sexual identity. Youth who reported their sexual identity as “not sure” also had increased odds of health risk behavior. Disaggregating bisexual identity and behavior from same-sex identity and behavior frequently resulted in the attenuation or elimination of health disparities that would have otherwise been attributable to exclusively same-sex sexual minorities. Finally, sexual behavior and sexual identity explained unique and significant sources of variability in all three health behaviors. CONCLUSION: Researchers using different operational definitions of sexual orientation could draw different conclusions, even when analyzing the same data, depending upon how they chose to represent sexual orientation in analyses. We discuss implications that these manipulations have on data interpretation and provide specific recommendations for best-practices when analyzing sexual orientation data collected from adolescent populations.

Matthews, D. D., & Lee, J. G. (2014). A profile of North Carolina lesbian, gay, and bisexual health disparities, 2011. Am J Public Health, 104(6), e98-e105. doi: 10.2105/ajph.2013.301751

OBJECTIVES: We investigated the health profile of lesbian, gay, and bisexual (LGB) adults in North Carolina, the first state in the South to include a measure of sexual orientation identity in a probability-based statewide health survey. METHODS: Using data from 9876 respondents in the 2011 North Carolina Behavioral Risk Factor Surveillance Survey, we compared sexual minorities to heterosexuals on a variety of health indicators. RESULTS: LGB respondents were younger and more likely to be reached by cell phone. Many examined indicators were not different by sexual orientation. Significant results, however, were consistent with findings from state population surveys in other regions of the country, including disparities in mental health and, among women, smoking. CONCLUSIONS: Reporting LGB identity in North Carolina is associated with poorer health. The concentration of anti-LGB policies in the South warrants ongoing monitoring of LGB health disparities in North Carolina and in other Southeastern states for potential effects on the health and well-being of LGB populations.

McGowan, I. (2014). An overview of antiretroviral pre-exposure prophylaxis of HIV infection. Am J Reprod Immunol, 71(6), 624-630. doi: 10.1111/aji.12225

Despite improvements in access to antiretroviral therapy and the use of simplified dosing regimens, HIV infection is still an important global public health problem. As a consequence, significant research efforts have been focused on the development of strategies to prevent the acquisition of HIV infection. These efforts have begun to produce results. The HPTN-052 study demonstrated the effectiveness of treating infected individuals as a means to prevent onward transmission of HIV infection. In addition, Phase 2B/3 studies have shown that the use of oral and topical antiretroviral pre-exposure prophylaxis (PrEP) can significantly reduce the acquisition of HIV infection in serodiscordant couples, young women in sub-Saharan Africa, men who have sex with men, and intravenous drug users. Despite these successes, challenges remain. Adherence to daily PrEP is variable, and some large studies have failed to demonstrate the effectiveness of PrEP in reducing HIV acquisition. Novel PrEP technologies, including sustained delivery intravaginal rings and long-acting injectable products, are being developed to try and circumvent adherence problems associated with daily PrEP regimens. The purpose of this article is to briefly summarize recent progress in the development of antiretroviral PrEP.

McGowan, I. (2014). The development of rectal microbicides for HIV prevention. Expert Opin Drug Deliv, 11(1), 69-82. doi: 10.1517/17425247.2013.860132

INTRODUCTION: Individuals practicing unprotected receptive anal intercourse are at particularly high risk of HIV infection. Men who have sex with men in the developed and developing world continue to have disproportionate and increasing levels of HIV infection. The last few years have seen important progress in demonstrating the efficacy of oral antiretroviral pre-exposure prophylaxis, vaginal microbicides, and treatment as prevention, but there has also been significant progress in the development of rectal microbicides for HIV prevention. AREAS COVERED: The purpose of this review is to summarize the status of rectal microbicide research and to identify opportunities, challenges, and future directions in this important field of HIV prevention research. The design of completed and ongoing Phase I rectal microbicide studies that include the generation of comprehensive pharmacokinetic/pharmacodynamic data may allow for more rational decisions about which rectal microbicides should be advanced to later stage development. EXPERT OPINION: There is a strong rationale for the development of rectal microbicides for HIV prevention. Preclinical data provide supportive evidence for the feasibility of this approach, and there is significant interest in rectal microbicide development from communities at risk of HIV acquisition through unprotected receptive anal intercourse in both the developed and developing world. Demonstration of sustained safety, acceptability, and product adherence in the MTN-017 Phase II study of tenofovir 1% gel will be an important step in rectal microbicide development and will hopefully lead to Phase III effectiveness testing of this novel HIV prevention strategy.

Meanley, S., Hickok, A., Johns, M. M., Pingel, E. S., & Bauermeister, J. A. (2014). Body mass index, body esteem, and unprotected receptive anal intercourse among young men who have sex with men who seek partners online. Arch Sex Behav, 43(4), 735-744. doi: 10.1007/s10508-013-0159-0

Research examining the relationship between body mass index (BMI) and sexual risk outcomes among men who have sex with men (MSM) has yielded inconsistent results. Using a web-based survey, single-identified (e.g., not in a relationship) young MSM (N = 431) between the ages of 18 and 24 years who sought romantic partners online were asked to respond to items regarding their BMI, body image (e.g., attribution, dissatisfaction, and pride), and sexual risk behaviors. We used Poisson regressions to examine the relationships between BMI, body image, and the number of unprotected receptive anal intercourse (URAI) occasions and partners in the past 2 months. We found a curvilinear relationship between BMI and URAI occasions, and a linear relationship between BMI and URAI partners. These relationships persisted after accounting for body image. Further, we found that body attribution served as a protective factor whereas body pride served as a risk factor. We discuss the implications of our findings for sexual health education and HIV prevention.

Mustanski, B., Andrews, R., Herrick, A., Stall, R., & Schnarrs, P. W. (2014). A syndemic of psychosocial health disparities and associations with risk for attempting suicide among young sexual minority men. Am J Public Health, 104(2), 287-294. doi: 10.2105/ajph.2013.301744

OBJECTIVES: We examined a syndemic of psychosocial health issues among young men who have sex with men (MSM), with men and women (MSMW), and with women (MSW). We examined hypothesized drivers of syndemic production and effects on suicide attempts. METHODS: Using a pooled data set of 2005 and 2007 Youth Risk Behavior Surveys from 11 jurisdictions, we used structural equation modeling to model a latent syndemic factor of depression symptoms, substance use, risky sex, and intimate partner violence. Multigroup models examined relations between victimization and bullying experiences, syndemic health issues, and serious suicide attempts. RESULTS: We found experiences of victimization to increase syndemic burden among all male youths, especially MSMW and MSM compared with MSW (variance explained = 44%, 38%, and 10%, respectively). The syndemic factor was shown to increase the odds of reporting a serious suicide attempt, particularly for MSM (odds ratio [OR] = 5.75; 95% confidence interval [CI] = 1.36, 24.39; P < .001) and MSMW (OR = 5.08; 95% CI = 2.14, 12.28; P < .001) compared with MSW (OR = 3.47; 95% CI = 2.50, 4.83; P < .001). CONCLUSIONS: Interventions addressing multiple psychosocial health outcomes should be developed and tested to better meet the needs of young MSM and MSMW.

Pines, H. A., Gorbach, P. M., Weiss, R. E., Shoptaw, S., Landovitz, R. J., Javanbakht, M., . . . Plankey, M. (2014). Sexual risk trajectories among MSM in the United States: implications for pre-exposure prophylaxis delivery. J Acquir Immune Defic Syndr, 65(5), 579-586. doi: 10.1097/qai.0000000000000101

BACKGROUND: Despite evidence supporting pre-exposure prophylaxis (PrEP) efficacy, there are concerns regarding the feasibility of widespread PrEP implementation among men who have sex with men (MSM). To inform the development of targeted PrEP delivery guidelines, sexual risk trajectories among HIV-negative MSM were characterized. METHODS: At semiannual visits from 2003 to 2011, HIV-negative MSM (N = 419) participating in the Multicenter AIDS Cohort Study provided data on sexual risk behaviors (SRBs) since their last visit. Based on their reported behaviors, participants were assigned a SRB score at each visit as follows: 0 = no insertive or receptive anal intercourse, 1 = no unprotected insertive or receptive anal intercourse, 2 = only unprotected insertive anal intercourse, 3 = unprotected receptive anal intercourse with 1 HIV-negative partner, 4 = condom serosorting, 5 = condom seropositioning, and 6 = no seroadaptive behaviors. Group-based trajectory modeling was used to examine SRB scores (<4 vs. >/=4) and identify groups with distinct sexual risk trajectories. RESULTS: Three sexual risk trajectory groups were identified: low-risk (n = 264; 63.0%), moderate-risk (n = 96; 22.9%; mean duration of consecutive high-risk intervals approximately 1 year), and high-risk (n = 59; 14.1%; mean duration of consecutive high-risk intervals approximately 2 years). Compared to low-risk group membership, high-risk group membership was associated with younger age (in years) [adjusted odds ratio (AOR) = 0.92, 95% confidence interval (CI): 0.88 to 0.96], being White (AOR = 3.67, 95% CI: 1.48 to 9.11), earning an income >/=$20,000 (AOR = 4.98, 95% CI: 2.13 to 11.64), distress/depression symptoms (Center for Epidemiologic Studies Depression Scale >/= 16) (AOR = 2.36, 95% CI: 1.14 to 4.92), and substance use (AOR = 2.00, 95% CI: 1.01 to 3.97). CONCLUSIONS: Screening for the sociodemographic and behavioral factors described above may facilitate targeted PrEP delivery during high-risk periods among MSM.

Russell, S. T., Toomey, R. B., Ryan, C., & Diaz, R. M. (2014). Being out at school: the implications for school victimization and young adult adjustment. Am J Orthopsychiatry, 84(6), 635-643. doi: 10.1037/ort0000037

Many lesbian, gay, bisexual, and transgender (LGBT) adolescents disclose their sexual and/or gender identities to peers at school. Disclosure of LGBT status is linked with positive psychosocial adjustment for adults; however, for adolescents, “coming out” has been linked to school victimization, which in turn is associated with negative adjustment. This study investigates the associations among adolescent disclosure of LGBT status to others at school, school victimization, and young adult psychosocial adjustment using a sample of 245 LGBT young adults (aged 21-25 years, living in California). After accounting for the association between school victimization and later adjustment, being out at high school was associated with positive psychosocial adjustment in young adulthood. Results have significant implications for training of school-based health and mental health providers, education and guidance for parents and caregivers, fostering positive development of LGBT youth, and developing informed school policies and educational practices.

Snowden, J. M., Wei, C., McFarland, W., & Raymond, H. F. (2014). Prevalence, correlates and trends in seroadaptive behaviours among men who have sex with men from serial cross-sectional surveillance in San Francisco, 2004-2011. Sex Transm Infect, 90(6), 498-504. doi: 10.1136/sextrans-2013-051368

OBJECTIVES: We sought to assess the prevalence and correlates of seroadaptive behaviours (i.e., sexual history incorporating some unprotected anal intercourse (UAI)) and conventional risk reduction behaviours (i.e., consistent condom use or no anal intercourse) among men who have sex with men (MSM) in San Francisco in 2011. We compared the prevalence of seroadaptive behaviours between serial cross-sectional surveys from 2004, 2008 and 2011. METHODS: We analysed data from the 2011 wave of the National HIV Behavioral Surveillance system in San Francisco. We categorised men’s self-reported sexual behaviour history in the past 6 months into a schema of seroadaptive behaviours and conventional risk reduction behaviours. We compared the prevalence of behaviour categories by self-reported HIV serostatus, HIV testing history, awareness of pre-exposure HIV prophylaxis (PrEP) and diagnosis of a sexually transmitted infection (STI). RESULTS: Seroadaptive behaviours remained common in San Francisco MSM, with a 2011 prevalence of 46.6%, up from 35.9% in 2004. Consistent condom use or no anal intercourse was more common than seroadaptive behaviours in HIV-negative MSM, men who had not heard of PrEP and men without an STI diagnosis. Seroadaptive behaviours increased from 2004 to 2011. CONCLUSIONS: HIV seroadaptive behaviours remain common in San Francisco MSM, have increased in the last decade and are practiced differently by MSM with different sexual health knowledge and outcomes. Public health researchers and officials should continue to document the prevalence, intentionality, efficacy and safety of seroadaptive behaviours among diverse communities of MSM.

Talley, A. E., Hughes, T. L., Aranda, F., Birkett, M., & Marshal, M. P. (2014). Exploring alcohol-use behaviors among heterosexual and sexual minority adolescents: intersections with sex, age, and race/ethnicity. Am J Public Health, 104(2), 295-303. doi: 10.2105/ajph.2013.301627

OBJECTIVES: We examined sexual orientation status differences in alcohol use among youths aged 13 to 18 years or older, and whether differences were moderated by sex, age, or race/ethnicity. METHODS: We pooled data from the 2005 and 2007 Youth Risk Behavior Surveys and conducted weighted analyses, adjusting for complex design effects. We operationalized sexual orientation status with items assessing sexual orientation identity, sexual behavior, sexual attraction, or combinations of these. RESULTS: Compared with exclusively heterosexual youths, sexual-minority youths were more likely to report each of the primary study outcomes (i.e., lifetime and past-month alcohol use, past-month heavy episodic drinking, earlier onset of drinking, and more frequent past-month drinking). Alcohol-use disparities were larger and more robust for (1) bisexual youths than lesbian or gay youths, (2) girls than boys, and (3) younger than older youths. Few differences in outcomes were moderated by race/ethnicity. CONCLUSIONS: Bisexual youths, sexual-minority girls, and younger sexual-minority youths showed the largest alcohol-use disparities. Research is needed that focuses on identifying explanatory or mediating mechanisms, psychiatric or mental health comorbidities, and long-term consequences of early onset alcohol use, particularly frequent or heavy use, among sexual-minority youths.

van Griensven, F., & Stall, R. D. (2014). Racial disparity in HIV incidence in MSM in the United States: how can it be reduced? Aids, 28(1), 129-130. doi: 10.1097/qad.0000000000000097

Wei, C., Lim, S. H., Guadamuz, T. E., & Koe, S. (2014). Virtual versus physical spaces: which facilitates greater HIV risk taking among men who have sex with men in East and South-East Asia? AIDS Behav, 18(8), 1428-1435. doi: 10.1007/s10461-013-0628-4

Increasing use of the Internet to seek sex partners is accompanied by rising HIV infections among men who have sex with men (MSM) in East and South-East Asia. We examined whether the Internet facilitates greater HIV risk taking among MSM in the region. A cross-sectional sample of 9,367 MSM was recruited via the Internet in 2010. We compared socio-demographic and HIV-related behavioral characteristics among MSM who met sex partners on the Internet only, who met sex partners offline only, and who met sex partners through both. Multinomial logistic regression was used to identify independent correlates that were associated with differences in where participants met their male sex partners. Compared to MSM who met partners offline only, those who met partners online only were less likely to have multiple male sex partners, have paid for sex, have consumed recreational drugs, and have used alcohol before sex. MSM who met partners both online and offline appeared to be the riskiest group that they were more likely to have multiple male sex partners, have engaged in UIAI, and have consumed alcohol before sex. These findings suggest that social networking websites alone do not facilitate greater HIV risk taking among MSM. Rather, they provide additional venues for MSM who already engage in HIV-related high risk behaviors to seek sex partners. The Internet offers incredible opportunities to reach large numbers of MSM in East and South-East Asia for HIV prevention and research. Web-based outreach and prevention activities are needed to reach these men. In addition, mobile and application-based interventions should also be developed and disseminated.

Wei, C., Muessig, K. E., Bien, C., Yang, L., Meng, R., Han, L., . . . Tucker, J. D. (2014). Strategies for promoting HIV testing uptake: willingness to receive couple-based and collective HIV testing among a cross-sectional online sample of men who have sex with men in China. Sex Transm Infect, 90(6), 469-474. doi: 10.1136/sextrans-2013-051460

OBJECTIVES: Low rates of HIV testing drive the rapidly growing HIV epidemic among men who have sex with men (MSM) in China. We examined the potential usefulness of couple-based and collective HIV testing strategies among Chinese MSM. METHODS: A cross-sectional online survey was conducted among 1113 MSM in 2013. Multivariable logistic regression analyses were conducted to identify factors associated with willingness to receive couple-based and collective testing. RESULTS: Acceptability of couple-based testing was very high among participants (86.1%), with a moderate level of interest in collective testing (43.2%). Being ‘out’ to others about one’s sexual identity (adjusted OR (AOR)=1.48, 95% CI 1.01 to 2.17) and having ever had an HIV test (AOR=3.05, 95% CI 2.10 to 4.33) were associated with willingness to receive couple-based testing. Having multiple male anal sex partners in the past 3 months was associated with willingness to participate in collective testing (AOR=1.43, 95% CI 1.03 to 1.99). DISCUSSION: Couple-based and collective HIV testing could help better control the HIV epidemic among Chinese MSM if implemented and promoted in a culturally competent manner.

 Wei, C., Yan, H., Yang, C., Raymond, H. F., Li, J., Yang, H., . . . Stall, R. (2014). Accessing HIV testing and treatment among men who have sex with men in China: a qualitative study. AIDS Care, 26(3), 372-378. doi: 10.1080/09540121.2013.824538

Barriers to HIV testing and HIV care and treatment pose significant challenges to HIV prevention among men who have sex with men (MSM) in China. We carried out a qualitative study to identify barriers and facilitators to HIV testing and treatment among Chinese MSM. In 2012, seven focus group (FG) discussions were conducted with 49 MSM participants in Nanjing, China. Purposive sampling was used to recruit a diverse group of MSM participants. Semi-structured interviews were conducted to collect FG data. Major barriers to testing included gay- and HIV-related stigma and discrimination, relationship type and partner characteristics, low perception of risk or threat, HIV is incurable or equals death, concerns of confidentiality, unaware that testing is offered for free, and name-based testing. Key facilitators of testing included engaging in high-risk sex, sense of responsibility for partner, collectivism, testing as a part of standard/routine medical care, MSM-friendly medical personnel, increased acceptance of gay/bisexual men by the general public, legal recognition and protection of homosexuals, and home self-testing. Barriers to treatment included negative coping, nondisclosure to families, misconceptions of domestically produced antiretroviral drugs (ARVs) and the benefits of treatment, and costs associated with long-term treatment. Facilitators of treatment included sense of hopefulness that a cure would be found, the cultural value of longevity, peer social support and professional psychological counseling, affordable and specialized treatment and care, and reduced HIV-related stigma and discrimination. Finally, for both testing and treatment, more educational and promotional activities within MSM communities and among the general public are needed.

Weiss L, Gass J, Egan JE, Ompad DC, Trezza C, Vlahov D. Understanding Prolonged Cessation from Heroin Use: Findings from a Community-Based Sample. Journal of Psychoactive Drugs, 46 (2), 123–132, 2014

There is abundant literature describing heroin initiation, co-morbidities, and treatment.  Few studies focus on cessation, examining the factors that motivate and facilitate it.  Methods: The CHANGE study utilized mixed methods to investigate heroin cessation among a low-income New York City population. This paper describes findings from qualitative interviews with 20 former and 11 current heroin users.  Interviews focused on background and current activities, supports, drug history, cessation attempts, and motivators and facilitators to cessation.  Results: Participants found motivation for cessation in improved quality of life; relationships; and fear of illness, incarceration and/or death.  Sustained cessation required some combination of treatment, strategic avoidance of triggers, and engagement in alternative activities, including support groups, exercise, and faith-based practice.  Several reported that progress toward goals served as motivators that increased confidence and facilitated cessation.  Ultimatums were key motivators for some participants. Beyond that, they could not articulate factors that distinguished successful from unsuccessful cessation attempts, although data suggest that those who were successful could describe more individualized and concrete—rather than general—motivators and strategies.  Conclusions:  Our findings indicate that cessation may be facilitated by multifaceted and individualized strategies, suggesting a need for personal and comprehensive approaches to treatment.

Yan, H., Yang, H., Li, J., Wei, C., Xu, J., Liu, X., . . . McFarland, W. (2014). Emerging disparity in HIV/AIDS disease progression and mortality for men who have sex with men, Jiangsu Province, China. AIDS Behav, 18 Suppl 1, S5-10. doi: 10.1007/s10461-013-0520-2

Few data exist on HIV disease progression and antiretroviral treatment (ART) impact among men who have sex with men (MSM) in China. Using data from the national case reporting system from 2004 to 2010, we describe changes in CD4 cell count before and after ART initiation, disease progression, and mortality among MSM in Jiangsu province compared with other persons living with HIV/AIDS. Median CD4 cell count among MSM at HIV diagnosis was 432 and decreased rapidly in 12 months to below the level of heterosexuals (slope: MSM -38.0, heterosexuals -15.5, injection drug users [IDU] -8.0, blood donors -10.5). Among those initiating ART, median CD4 cell count among MSM was 157, yet the increase in count was slower than for other groups (slope: MSM 26.9, heterosexuals 31.9, IDU 29.0, blood donors 35.0). Progression to AIDS was faster among MSM than heterosexuals and IDU. For the present, the mortality rate was lower for MSM compared with heterosexuals and blood donors; however, against a backdrop of more recent infection (ie, MSM had younger age, and 93.8 % were diagnosed after 2008), findings suggest a survival rate for MSM that will fall behind other groups. Improved medical and psychosocial supportive care is needed for this stigmatized population lest disparities become greater.

Yan, H., Yang, H., Raymond, H. F., Li, J., Shi, L. E., Huan, X., & Wei, C. (2014). Experiences and Correlates of HIV Self-Testing Among Men Who Have Sex with Men in Jiangsu Province, China. AIDS Behav. doi: 10.1007/s10461-014-0968-8

Substantial numbers of Chinese men who have sex with men (MSM) do not access facility-based HIV testing. Self-testing could promote testing uptake among this population. We describe experiences and identify correlates of self-testing among Chinese MSM. A cross-sectional survey was conducted among MSM in Jiangsu from November 2013 to January 2014. Participants were recruited through time-location sampling and from online. Participants were asked a series of questions about HIV self-testing uptake and associated experiences. Logistic regression was used to identify correlates of having ever self-tested for HIV. Of 522 participants, 26.2 % had ever self-tested. Finger stick was the most common self-testing modality (86.1 %). A majority of participants reported that it was “very easy” (43.1 %) or “somewhat easy” (34.3 %) to perform self-testing while lower proportions reported “very confident” (24.1 %) or “somewhat confident” (36.5 %) in the accuracy of their test results. Having ever self-tested was significantly associated with having had 2-5 and 6 or more male anal sex partners in the past 6 months (AOR 2.12, 95 % CI 1.00, 4.49; AOR 4.95, 95 % CI 1.90, 12.87), having ever tested for HIV (AOR 4.56, 95 % CI 1.66, 12.55), and having a friend or friends who self-tested (AOR 7.32, 95 % CI 3.57, 15.00). HIV self-testing can reach untested Chinese MSM and/or increase testing frequency. Peer- or social network-based interventions could further help encourage self-testing. Monitoring systems should be strengthened to ensure the quality of self-testing kits and provision of essential support services, including post-test counseling and linkage-to-care.

Yan, H., Zhang, R., Wei, C., Li, J., Xu, J., Yang, H., & McFarland, W. (2014). A peer-led, community-based rapid HIV testing intervention among untested men who have sex with men in China: an operational model for expansion of HIV testing and linkage to care. Sex Transm Infect, 90(5), 388-393. doi: 10.1136/sextrans-2013-051397

OBJECTIVES: To examine outcomes of a peer-led, community-based intervention providing rapid HIV testing and case management for linkage to care for untested men who have sex with men (MSM) in China. METHODS: Rapid HIV testing was performed by trained peer volunteers of a community-based organisation (CBO) in three cities of Jiangsu province at MSM-oriented venues. MSM screened positive were referred and accompanied to local government health agencies (Centres for Disease Control and Prevention (CDC)) for confirmatory HIV testing and provided social support for up to 1 month. Data for the programme were compared with sentinel surveillance surveys of MSM conducted by the national and provincial CDC in the province during the same year to assess differences in the populations reached, in HIV positivity, and linkage to HIV care. RESULTS: A total of 512 previously untested MSM were tested by the CBO programme in 6 months. Compared with those in the surveillance surveys, MSM tested by the CBO were significantly more likely to be younger, single, non-resident of the province, more educated and used condoms less frequently. Higher proportions of HIV-positive MSM screened by the CBO received their confirmatory test results (98.1% vs 72.6%, p<0.001) and linked to care (90.4% vs 42.0%, p<0.001). CONCLUSIONS: Trained peers providing rapid HIV testing with social support and case management through the early period following diagnosis can efficiently expand HIV testing and improve linkage to care among MSM in China.

 

2013

Althoff, K. N., Jacobson, L. P., Cranston, R. D., Detels, R., Phair, J. P., Li, X., & Margolick, J. B. (2013). Age, Comorbidities, and AIDS Predict a Frailty Phenotype in Men Who Have Sex With Men. J Gerontol A Biol Sci Med Sci. doi: 10.1093/gerona/glt148

Adults aging with HIV infection are at risk for age-related comorbidities and syndromes, such as frailty. The objective of this study was to evaluate the expression and predictors of the frailty phenotype (FP) among HIV-infected (HIV+) and HIV-uninfected (HIV-) men who have sex with men. METHODS: A prospective, observational cohort study was nested in the Multicenter AIDS Cohort Study from October 2007-September 2011. FP conversion was defined as the onset of FP over two consecutive study visits. Adjusted odds ratios and 95% confidence intervals ([,]) for FP conversion were estimated using logistic regression models with generalized estimating equations. RESULTS: Of 10,571 completed study visits from 1,946 men who have sex with men, 12% and 9% were FP+ among HIV+ and HIV- men, respectively (p = .002). The proportion of FP+ visits increased with age regardless of HIV status, but was significantly greater in HIV+ compared to HIV- men aged 50-64 years. Of the 10,276 consecutive visit pairs contributed by participants, 5% (537) were classified as FP conversion, and 45% of the men with FP conversion had only one FP+ study visit. FP conversion was significantly associated with a history of AIDS (adjusted odds ratios = 2.26 [1.50, 3.39], but not with HIV+ alone (adjusted odds ratios = 1.26 [0.98, 1.64]). Among men who had one or more FP+ visits, 34% of HIV+ and 38% of HIV- men had less than two comorbidities. CONCLUSIONS: These findings suggest that expression of the FP can be measured in men who have sex with men with and without HIV infection and reflects multisystem dysfunction in this population; further investigations are needed to better understand clinical utility.

Andersen, J., & Blosnich, J. R. (2013). Disparities in adverse childhood events among sexual minority and heterosexual adults: Results From a multi-state probability-based sample. PLoS-One, 8(1). doi: 10.1371/journal.pone.0054691

Baral, S. D., Poteat, T., Guadamuz, T. E., & Beyrer, C. (2013). Sampling bias in transgender studies–authors’ reply. Lancet Infect Dis, 13(10), 832-833. doi: 10.1016/s1473-3099(13)70261-5

Baral, S. D., Poteat, T., Stromdahl, S., Wirtz, A. L., Guadamuz, T. E., & Beyrer, C. (2013). Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis, 13(3), 214-222. doi: 10.1016/s1473-3099(12)70315-8

Previous systematic reviews have identified a high prevalence of HIV infection in transgender women in the USA and in those who sell sex (compared with both female and male sex workers). However, little is known about the burden of HIV infection in transgender women worldwide. We aimed to better assess the relative HIV burden in all transgender women worldwide. METHODS: We did a systematic review and meta-analysis of studies that assessed HIV infection burdens in transgender women that were published between Jan 1, 2000, and Nov 30, 2011. Meta-analysis was completed with the Mantel-Haenszel method, and random-effects modelling was used to compare HIV burdens in transgender women with that in adults in the countries for which data were available. FINDINGS: Data were only available for countries with male-predominant HIV epidemics, which included the USA, six Asia-Pacific countries, five in Latin America, and three in Europe. The pooled HIV prevalence was 19.1% (95% CI 17.4-20.7) in 11 066 transgender women worldwide. In 7197 transgender women sampled in ten low-income and middle-income countries, HIV prevalence was 17.7% (95% CI 15.6-19.8). In 3869 transgender women sampled in five high-income countries, HIV prevalence was 21.6% (95% CI 18.8-24.3). The odds ratio for being infected with HIV in transgender women compared with all adults of reproductive age across the 15 countries was 48.8 (95% CI 21.2-76.3) and did not differ for those in low-income and middle-income countries compared with those in high-income countries. INTERPRETATION: Our findings suggest that transgender women are a very high burden population for HIV and are in urgent need of prevention, treatment, and care services. The meta-analysis showed remarkable consistency and severity of the HIV disease burden among transgender women. FUNDING: Center for AIDS Research at Johns Hopkins and the Center for Public Health and Human Rights at the JHU Bloomberg School of Public Health.

Berry, J. M., Jay, N., Cranston, R. D., Darragh, T. M., Holly, E. A., Welton, M. L., & Palefsky, J. M. (2013). Progression of anal high-grade squamous intraepithelial lesions to invasive anal cancer among HIV-infected men who have sex with men. Int J Cancer. doi: 10.1002/ijc.28431

The incidence of anal cancer is elevated in human immunodeficiency virus (HIV)-infected men-who-have-sex-with-men (MSM) compared to the general population. Anal high-grade squamous intraepithelial lesions (HSIL) are common in HIV-infected MSM and the presumed precursors to anal squamous cell cancer; however, direct progression of HSIL to anal cancer has not been previously demonstrated. The medical records were reviewed of 138 HIV-infected MSM followed up at the University of California, San Francisco, who developed anal canal or perianal squamous cancer between 1997 and 2011. Men were followed up regularly with digital anorectal examination (DARE), high-resolution anoscopy (HRA) and HRA-guided biopsy. Although treatment for HSIL and follow-up were recommended, not all were treated and some were lost to follow-up. Prevalent cancer was found in 66 men. Seventy-two HIV-infected MSM developed anal cancer while under observation. In 27 men, anal cancer developed at a previously biopsied site of HSIL. An additional 45 men were not analyzed in this analysis due to inadequate documentation of HSIL in relation to cancer location. Of the 27 men with documented progression to cancer at the site of biopsy-proven HSIL, 20 men progressed from prevalent HSIL identified when first examined and seven men from incident HSIL. Prevalent HSIL progressed to cancer over an average of 57 months compared to 64 months for incident HSIL. Most men were asymptomatic, and cancers were detected by DARE. Anal HSIL has clear potential to progress to anal cancer in HIV-infected MSM. Early diagnosis is facilitated by careful follow-up. Carefully controlled studies evaluating efficacy of screening for and treatment of HSIL to prevent anal cancer are needed.

Blosnich, J., & Bossarte, R. (2013). Suicide acceptability among U.S. Veterans with active duty experience: results from the 2010 General Social Survey. Arch Suicide Res, 17(1), 52-57. doi: 10.1080/13811118.2013.748415

The objective of this study was to examine whether U.S. Veterans more frequently indicate suicide acceptability than non-Veterans. The 2010 General Social Survey, which employed a probability-based sample of U.S. adults, was analyzed by self-reported Veteran status on suicide acceptability in four, separate hypothetical situations regarding ending one’s life (i.e., incurable illness, bankruptcy, bringing dishonor/shame upon family, tired of living and ready to die). Veterans were no more likely to endorse suicide as acceptable than their non-Veteran counterparts. Results suggest that attitudes approving of suicide are not different among Veterans in general and non-Veterans. However, future research may need to examine whether subpopulations of Veterans with elevated risk for suicide may report differential attitudes about suicide.

Blosnich, J., Bossarte, R., Silver, E., & Silenzio, V. (2013). Health care utilization and health indicators among a national sample of U.S. veterans in same-sex partnerships. Mil Med, 178(2), 207-212.

To examine health indicators of same-sex partnered veterans as compared with their opposite-sex partnered veteran and nonveteran peers. METHODS: Same-sex partner status was derived by self-reported same-sex partnerships in data from the 2004 Behavioral Risk Factor Surveillance System. Outcome variables included health risk disparities associated with sexual minority status (e.g., frequent mental distress) and veteran status (e.g., firearm ownership). Stratified multiple logistic regression models were used to examine the association of same-sex partnered veteran status with health indicators. RESULTS: Same-sex partnered veterans had higher odds of being overweight and keeping firearms in the house compared with same-sex partnered nonveterans. Same-sex partnered veterans were less likely than opposite-sex partnered veterans to be overweight, and they were more than twice as likely to be current smokers when compared with opposite-sex partnered nonveterans. CONCLUSIONS: Findings suggest both that some health disparities patterns identified by same-sex partnership status among the general population also exist among veteran populations, and that some unique distinctions may exist, particularly related to BMI and firearm ownership. Collection of information about sexual minority status within Department of Veterans Affairs data sources is needed to more accurately assess the health of this minority population.

Blosnich, J., Foynes, M. M., & Shipherd, J. C. (2013). Health disparities among sexual minority women veterans. J Womens Health (Larchmt), 22(7), 631-636. doi: 10.1089/jwh.2012.4214

Lesbian and bisexual (i.e., sexual minority) identity is more common among women veterans than among male veterans. Unique health issues have been identified among women veterans and among sexual minority women, but little is known about women who are both sexual minorities and veterans. This study aimed to compare demographic and health information from sexual minority women veterans with sexual minority women non-veterans and heterosexual women veterans. METHODS: Behavioral Risk Factor Surveillance Survey data were pooled from ten U.S. states that elected to ask sexual identity during 2010. The analytic sample was comprised of women who identified both their sexual identity and veteran status (n=1,908). Mental health indicators were frequent mental distress, sleep problems, low social/emotional support, and low satisfaction with life. Health risk indicators included current smoking, overweight, and obesity. Physical health status was defined by three components: disability requiring assistive equipment, >14 days of poor physical health in the past 30 days, and activity limitations. RESULTS: Compared with heterosexual women veterans, sexual minority women veterans had higher odds of mental distress (odds ratio [OR]=3.03, 95% confidence interval [CI]: 1.61-5.70) and smoking (OR=2.31, 95%CI: 1.19-4.48). After adjusting for demographic correlates, sexual minority women veterans had three times the odds of poor physical health (OR=3.01, 95%CI: 1.51-5.99) than their sexual minority non-veteran peers. CONCLUSIONS: Results suggest sexual minority women veterans may experience unique health disparities relevant to provision of care in both Veterans Affairs (VA) and non-VA healthcare systems. Future research requires availability of data that include sexual minority status.

Blosnich, J. R., Brown, G. R., Shipherd Phd, J. C., Kauth, M., Piegari, R. I., & Bossarte, R. M. (2013). Prevalence of gender identity disorder and suicide risk among transgender veterans utilizing veterans health administration care. Am J Public Health, 103(10), e27-32. doi: 10.2105/ajph.2013.301507

We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis. METHODS: We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009-2011) of suicide-related events among all VHA users to examine suicide risk. RESULTS: GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population. CONCLUSIONS: The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care.

Blosnich, J. R., Lee, J. G., Bossarte, R., & Silenzio, V. M. (2013). Asthma disparities and within-group differences in a national, probability sample of same-sex partnered adults. Am J Public Health, 103(9), e83-87. doi: 10.2105/ajph.2013.301217

We examined the prevalence and correlates of self-reported lifetime diagnosis of asthma and current asthma among same-sex and opposite-sex partnered adults. METHODS: Data were from the 2004 Behavioral Risk Factor Surveillance System, in which same-sex partnership was a response option to a family planning item in the core questionnaire. Self-reported lifetime diagnosis of asthma and current asthma were examined in logistic regression models adjusted for demographic characteristics and asthma-related confounding factors and stratified by both gender and same-sex partnership status. RESULTS: Significantly higher proportions of same-sex partnered male and female respondents reported lifetime and current asthma compared with their opposite-sex partnered peers. In adjusted analyses, same-sex partnership status remained significantly associated with asthma outcomes among men and women, with odds ratios ranging from 1.57 to 2.34. CONCLUSIONS: Results corroborated past studies that indicated asthma disproportionately affects sexual minority populations. The addition of sexual minority status questions to federal survey projects is key to further exploring health disparities in this population. Future studies are needed to investigate the etiology of this disparity.

Blosnich, J. R., & Silenzio, V. M. (2013). Physical health indicators among lesbian, gay, and bisexual U.S. veterans. Ann Epidemiol, 23(7), 448-451. doi: 10.1016/j.annepidem.2013.04.009

To provide information about lesbian, gay, and bisexual (LGB) veterans’ health status, diagnoses, and health screening behaviors compared with heterosexual veterans. METHODS: Data are from 10 states’ 2010 Behavioral Risk Factor Surveillance System surveys that contained sexual orientation data for veterans (n = 11,665). chi(2) tests and multiple logistic regression were used to examine outcomes among LGB and heterosexual veterans. RESULTS: More LGB than heterosexual veterans reported current smoking, not seeking medical care owing to cost, and activity limitations. Compared with heterosexual veterans, LGB veterans had greater odds of ever having an human immunodeficiency virus test (odds ratio [OR], 5.42; 95% confidence interval [CI], 3.28-8.96) but lower odds of diabetes diagnosis (OR, 0.55; 95% CI, 0.34-0.89). CONCLUSIONS: Findings from this sample suggest patterns of health behaviors and outcomes among LGB veterans that are both unique from and similar to results from general samples of LGB persons. With the formal end of the “Don’t Ask, Don’t Tell” policy that discriminated against LGB people in the military, institutions such as the Department of Veterans Affairs are likely to see an increase in its current population of LGB veterans. The Department of Veterans Affairs stands in a unique place to meet the health equity needs of this minority population.

Bossarte, R. M., Blosnich, J. R., Piegari, R. I., Hill, L. L., & Kane, V. (2013). Housing Instability and Mental Distress among US Veterans. Am J Public Health, 103 Suppl 2, S213-216. doi: 10.2105/ajph.2013.301277

Evidence has suggested increased risk for homelessness and suicide among US veterans, but little is known about the associations between housing instability and psychological distress (including suicidal ideation). We examined frequent mental distress (FMD) and suicidal ideation among a probability-based sample of 1767 Nebraska veterans who participated in the 2010 Behavioral Risk Factor Surveillance Survey who had and had not experienced housing instability in the past 12 months. Veterans experiencing housing instability had increased odds of FMD and suicidal ideation.

Burton, C. M., Marshal, M. P., Chisolm, D. J., Sucato, G. S., & Friedman, M. S. (2013). Sexual minority-related victimization as a mediator of mental health disparities in sexual minority youth: a longitudinal analysis. J Youth Adolesc, 42(3), 394-402. doi: 10.1007/s10964-012-9901-5

Sexual minority youth (youth who are attracted to the same sex or endorse a gay/lesbian/bisexual identity) report significantly higher rates of depression and suicidality than heterosexual youth. The minority stress hypothesis contends that the stigma and discrimination experienced by sexual minority youth create a hostile social environment that can lead to chronic stress and mental health problems. The present study used longitudinal mediation models to directly test sexual minority-specific victimization as a potential explanatory mechanism of the mental health disparities of sexual minority youth. One hundred ninety-seven adolescents (14-19 years old; 70 % female; 29 % sexual minority) completed measures of sexual minority-specific victimization, depressive symptoms, and suicidality at two time points 6 months apart. Compared to heterosexual youth, sexual minority youth reported higher levels of sexual minority-specific victimization, depressive symptoms, and suicidality. Sexual minority-specific victimization significantly mediated the effect of sexual minority status on depressive symptoms and suicidality. The results support the minority stress hypothesis that targeted harassment and victimization are partly responsible for the higher levels of depressive symptoms and suicidality found in sexual minority youth. This research lends support to public policy initiatives that reduce bullying and hate crimes because reducing victimization can have a significant impact on the health and well-being of sexual minority youth.

Cranston, R. D. (2013). Young Gay Men and the Quadrivalent Human Papillomavirus Vaccine – Much to Gain (and Lose). J Infect Dis. doi: 10.1093/infdis/jit627

Dermody, S. S., Marshal, M. P., Cheong, J., Burton, C., Hughes, T., Aranda, F., & Friedman, M. S. (2013). Longitudinal Disparities of Hazardous Drinking Between Sexual Minority and Heterosexual Individuals from Adolescence to Young Adulthood. J Youth Adolesc. doi: 10.1007/s10964-013-9905-9

Sexual minority (lesbian and gay, bisexual, mostly heterosexual) individuals are at an increased risk for hazardous drinking than heterosexual individuals, but little is known about the nature of the disparities as adolescents reach adulthood. We used four waves of a nationally representative data set, the National Longitudinal Study of Adolescent Health (Add Health), to examine disparities of hazardous drinking outcomes between sexual minority and heterosexual men and women from adolescence to young adulthood. Participants were 14-18 years old at the first assessment (N = 12,379; 53 % female) and 27-31 years old at the fourth assessment. At the fourth assessment, 13 % self-identified as sexual minority individuals, 16 % were Hispanic, and 36 % were of minority race, including primarily African Americans (60 %) and Asian Americans (18 %). There were clear hazardous drinking disparities between sexual minority individuals and heterosexual individuals over time. During adolescence, sexual minority individuals, particularly females, reported higher levels of hazardous drinking. As study participants reached adulthood, the magnitude of the hazardous drinking disparities increased among sexual minorities, sexual minority men in particular. Additional research is needed to better understand the developmental mechanisms that underlie the emerging sexual orientation related disparities of hazardous drinking in young adulthood.

D’Souza, G., Rajan, S. D., Bhatia, R., Cranston, R. D., Plankey, M. W., Silvestre, A., . . . Brewer, N. T. (2013). Uptake and predictors of anal cancer screening in men who have sex with men. Am J Public Health, 103(9), e88-95. doi: 10.2105/ajph.2013.301237

We investigated attitudes about and acceptance of anal Papanicolaou (Pap) screening among men who have sex with men (MSM). METHODS: Free anal Pap screening (cytology) was offered to 1742 MSM in the Multicenter AIDS Cohort Study, who reported history of, attitudes about, and experience with screening. We explored predictors of declining screening with multivariate logistic regression. RESULTS: A history of anal Pap screening was uncommon among non-HIV-infected MSM, but more common among HIV-infected MSM (10% vs 39%; P < .001). Most participants expressed moderate or strong interest in screening (86%), no anxiety about screening (66%), and a strong belief in the utility of screening (65%). Acceptance of screening during this study was high (85%) across all 4 US sites. Among those screened, most reported it was “not a big deal” or “not as bad as expected,” and 3% reported that it was “scary.” Declining to have screening was associated with Black race, anxiety about screening, and low interest, but not age or HIV status. CONCLUSIONS: This study demonstrated high acceptance of anal Pap screening among both HIV-infected and non-HIV-infected MSM across 4 US sites.

Friedman, M. R., Kurtz, S. P., Buttram, M. E., Wei, C., Silvestre, A. J., & Stall, R. (2013). HIV Risk Among Substance-Using Men Who Have Sex with Men and Women (MSMW): Findings from South Florida. AIDS Behav. doi: 10.1007/s10461-013-0495-z

Compared with men who have sex with men only (MSMO), men who have sex with men and women (MSMW) consistently report higher rates of two HIV risk behaviors: transactional sex (TS) and concurrent substance use and sex (CSS). Within MSMW, little is known about how synergistic epidemics (“syndemics”) affect TS and CSS. Using a sample of substance-using MSM (n = 515) in South Florida, we compared TS and CSS among MSMO and MSMW; examined whether, within MSMW (n = 86), TS and CSS predict unprotected anal intercourse with partners of serodiscordant/unknown HIV status (SU-UAI); and tested whether syndemics predict TS and CSS. MSMW reported higher rates of engaging in both TS and CSS (AOR = 1.7; 95 % CI 1.0-3.0). Within MSMW, engagement in both TS and CSS predicted SU-UAI (AOR = 3.3; 95 % CI 1.2-9.6); and syndemics predicted TS and CSS involvement (p < 0.01). Substance-using MSMW may benefit from interventions targeting TS, CSS, and background syndemics.

Hawk, M. (2103) The Girlfriends Project: Results of a Pilot Study Assessing Feasibility of an HIV Testing and Risk Reduction Intervention Developed, Implemented, and Evaluated in Community Settings. AIDS Education and Prevention, 25(6) : 519-534. doi: 10.1521/aeap.2013.25.6.519

African American women in the United States experience significant HIV health disparities. The majority of evidence-based risk reduction interventions do not incorporate HIV testing, and most are targeted only to narrow segments of the population such as women who are pregnant or seen in STI clinics. This pilot study assessed the feasibility and efficacy of The Girlfriends Project (TGP), a community developed and community evaluated HIV risk reduction and testing intervention. A group randomized wait-list design was used to recruit 149 women and to compare findings for intervention group versus control group participants. Women in the intervention group demonstrated statistically-significant increases in HIV knowledge scores and in condom use during vaginal sex. Eighty-seven percent of participants accessed HIV testing with a 100% return rate for results. Study findings suggest that TGP has the potential to be an effective intervention and to increase number of African American women who access HIV testing.

Herrick, A., Kuhns, L., Kinsky, S., Johnson, A., & Garofalo, R. (2013). Demographic, psychosocial, and contextual factors associated with sexual risk behaviors among young sexual minority women. J Am Psychiatr Nurses Assoc, 19(6), 345-355. doi: 10.1177/1078390313511328

Young sexual minority women are at risk for negative sexual health outcomes, including sexually transmitted infections and unintended pregnancies, yet little is known about these risks. We examined factors that may influence sexual risk from a psychosocial and contextual perspective. Analyses were conducted to examine within group relationships between sexual behaviors, negative outcomes, and related factors in a sample of young sexual minority women. Participants (N = 131) were young (mean = 19.8) and diverse in terms of race/ethnicity (57% non-White). Sex under the influence, having multiple partners, and having unprotected sex were common behaviors, and pregnancy (20%) and sexually transmitted infection (12%) were common outcomes. Risk behaviors were associated with age, alcohol abuse, and older partners. Results support the need for further research to understand how these factors contribute to risk in order to target risk reduction programs for this population.

Herrick, A. L., Lim, S. H., Plankey, M. W., Chmiel, J. S., Guadamuz, T. E., Kao, U., . . . Stall, R. (2013). Adversity and syndemic production among men participating in the multicenter AIDS cohort study: a life-course approach. Am J Public Health, 103(1), 79-85. doi: 10.2105/ajph.2012.300810

We tested a theory of syndemic production among men who have sex with men (MSM) using data from a large cohort study. METHODS: Participants were 1551 men from the Multicenter AIDS Cohort Study enrolled at 4 study sites: Baltimore, Maryland-Washington, DC; Chicago, Illinois; Los Angeles, California; and Pittsburgh, Pennsylvania. Participants who attended semiannual visits from April 1, 2008, to March 31, 2009, completed an additional survey that captured data about events throughout their life course thought to be related to syndemic production. RESULTS: Using multivariate analysis, we found that the majority of life-course predictor variables (e.g., victimization, internalized homophobia) were significantly associated with both the syndemic condition and the component psychosocial health outcomes (depressive symptoms, stress, stimulant use, sexual compulsivity, intimate partner violence). A nested negative binomial analysis showed that the overall life course significantly explained variability in the syndemic outcomes (chi(2) = 247.94; P < .001; df = 22). CONCLUSIONS: We identified life-course events and conditions related to syndemic production that may help to inform innovative interventions that will effectively disentangle interconnecting health problems and promote health among MSM.

Herrick, A. L., Stall, R., Chmiel, J. S., Guadamuz, T. E., Penniman, T., Shoptaw, S., . . . Plankey, M. W. (2013). It gets better: resolution of internalized homophobia over time and associations with positive health outcomes among MSM. AIDS Behav, 17(4), 1423-1430. doi: 10.1007/s10461-012-0392-x

Health disparities research among gay and bisexual men has focused primarily on risk and deficits. However, a focus on resiliencies within this population may greatly benefit health promotion. We describe a pattern of resilience (internalized homophobia (IHP) resolution) over the life-course and its associations with current health outcomes. 1,541 gay and bisexual men from the Multi-Center AIDS Cohort study, an ongoing prospective study of the natural and treated histories of HIV, completed a survey about life-course events thought to be related to health. The majority of men resolved IHP over time independent of demographics. Men who resolved IHP had significantly higher odds of positive health outcomes compared to those who did not. These results provide evidence of resilience among participants that is associated with positive health outcomes. Understanding resiliencies and incorporating them into interventions may help to promote health and well-being among gay and bisexual men.

Herrick, A. L., Stall, R., Goldhammer, H., Egan, J. E., & Mayer, K. H. (2013). Resilience as a Research Framework and as a Cornerstone of Prevention Research for Gay and Bisexual Men: Theory and Evidence. AIDS Behav. doi: 10.1007/s10461-012-0384-x

This commentary presents the content and results of a recent symposium held to discuss how resiliencies among gay and bisexual men, and other men who have sex with men, could inform HIV prevention interventions. We outline the argument for including resiliencies in prevention work and present a critique of the deficit-based approached to public health research as it applies to this line of inquiry. The commentary makes the case that HIV prevention work would be more efficacious if it were designed to incorporate naturally occurring resiliencies that manifest among gay male communities rather than primarily using interventions that address vulnerabilities among men who continue to reside in high risk contexts. The commentary concludes by listing a set of resiliency variables and constructs proposed at the meeting that could be tested in theoretically-based investigations to raise resiliencies among gay and bisexual men thereby lowering HIV risks in this population.

Herrick AL, Egan JE, Coulter RWS, Friedman MR, Stall R. Intervening to raise levels of health among sexual minority health by incorporating resiliencies into health promotion efforts. American Journal of Public Health (In Press)

Myriad health inequities experienced by sexual minority youth (SMY) have been documented over the past several decades. Evidence supports the conclusion that these are not a result of intrinsic characteristics, rather, they result from high levels of adversity experienced by SMY.  Despite the pervasive marginalization that SMY face there is also evidence of great resilience within this population. It seems likely that if a culture of marginalization produces health inequities in SMY, then a culture of acceptance and integration can work to produce resiliencies. We describe how promoting forms of acceptance and integration could work to promote resilient SMY despite an overarching culture of marginalization. Building on the resiliencies of SMY may potentiate the effectiveness of health promotion interventions to reduce health disparities within this population.

Hightow-Weidman, L. B., Pike, E., Fowler, B., Matthews, D. M., Kibe, J., McCoy, R., & Adimora, A. A. (2012). HealthMpowerment.org: feasibility and acceptability of delivering an internet intervention to young Black men who have sex with men. AIDS Care, 24(7), 910-920. doi: 10.1080/09540121.2011.647677

Young Black men who have sex with men (BMSM) are disproportionately affected by HIV/AIDS in the USA and continue to experience rapidly increasing HIV incidence. We designed a tailored, theory-based interactive HIV/STI prevention website for young BMSM, called HealthMpowerment.org (HMP) and conducted a small pilot trial comparing HMP to currently available HIV/STI websites. We present findings demonstrating feasibility and acceptability of delivering the intervention to the target population of young BMSM. Retention rates were 90% and 78% at one- and three-month follow-ups, respectively. Evaluation immediately after the intervention’s completion revealed that participants who used the HMP website reported high levels of user satisfaction and interest and low levels of website difficulty and frustration. At the end of the intervention, there was a trend in increased behavioral intentions to use condoms and engage in preparatory condom use behaviors in the intervention group compared to the control group (p=0.10). We observed a reduction in mean scores on the CES-D scale among those in the intervention group that was not seen in the control group at the one-month follow-up, though this was not statistically significant. Feedback from exit interviews with study participants suggested that HMP is relevant to the prevention needs of young BMSM. Overall, the findings support the acceptability and feasibility of delivering this prevention program to a group that has few interventions despite bearing a significant burden of the epidemic. Future trials, combining Internet and mobile phone technologies, are planned to test HMP among larger and more diverse populations of young BMSM.

Hsu, H., Brown, T., Li, X., Young, S., Cranston, R. D., D’Souza, G., . . . Wiley, D. J. (2013). 17. Serum free testosterone levels associated with anal human papillomavirus types 16/18 in a cohort of men who have sex with men. Sex Health, 10(6), 578. doi: 10.1071/SHv10n6ab17

Background Human papillomavirus (HPV) types 16/18 are significant causes of female cervical cancers and likely cause most anal cancers. Oestrogen influences HPV-related cervical malignancies; however, the role of testosterone in anal HPV16/18 infections is unknown. Methods: 340 men who have sex with men (MSM) enrolled in the Multicenter AIDS Cohort Study were tested for serum free testosterone (SFT) and, ~24 months later, anal HPV16/18-DNA. Poisson regression with robust error variance analyses estimated prevalence ratios for HPV16/18 infections with the following exposures: log10-transformed SFT, exogenous and supraphysiological testosterone measures, race, age, self-reported number of anal receptive intercourse partnerships </=24 months before testing, enrolment period, body mass index, hepatitis C infection, tobacco and alcohol, HIV infection, and CD4+ T-cell counts among the HIV-infected. Stratified-tabular analyses also evaluated blood draw timing (AM/PM), study site, and time on study. Results: 89% (304/340) of men provided complete data for all covariates. On average, men were White (263/304), 60 years old (s.d. 5.3; median 60.1 years) with 76.2ngdL(-1) (s.d. 57.1; median 69.0ngdL(-1)) SFT, and 43% (132/304) were HIV infected; 25% (75/304) tested HPV16/18-DNA positive. The fully adjusted model suggests each half-log10 increase of SFT is associated with a 1.69-fold (95% confidence interval (CI): 1.08, 2.64) higher HPV16/18 prevalence. Compared with HIV-uninfected men, HPV16/18 prevalence was 1.81-fold higher (95% CI: 1.08, 3.03) for HIV-infected men with </=500 CD4+ T-cells mm(-3). No other covariates were significantly associated with HPV16/18 prevalence. Conclusions: Higher free testosterone is associated with increased HPV16/18 prevalence in MSM, independent of sexual behaviour and other potential confounders. The mechanisms underlying this association remain unclear and warrant further study.

Koblin, B. A., Egan, J. E., Rundle, A., Quinn, J., Tieu, H. V., Cerda, M., . . . Frye, V. (2013). Methods to measure the impact of home, social, and sexual neighborhoods of urban gay, bisexual, and other men who have sex with men. PLoS One, 8(10), e75878. doi: 10.1371/journal.pone.0075878

Men who have sex with men (MSM) accounted for 61% of new HIV diagnoses in the United States in 2010. Recent analyses indicate that socio-structural factors are important correlates of HIV infection. NYCM2M was a cross-sectional study designed to identify neighborhood-level characteristics within the urban environment that influence sexual risk behaviors, substance use and depression among MSM living in New York City. The sample was recruited using a modified venue-based time-space sampling methodology and through select websites and mobile applications. This paper describes novel methodological approaches used to improve the quality of data collected for analysis of the impact of neighborhoods on MSM health. Previous research has focused predominately on residential neighborhoods and used pre-determined administrative boundaries (e.g., census tracts) that often do not reflect authentic and meaningful neighborhoods. This study included the definition and assessment of multiple neighborhoods of influence including where men live (home neighborhood), socialize (social neighborhood) and have sex (sexual neighborhood). Furthermore, making use of technological advances in mapping, we collected geo-points of reference for each type of neighborhood and identified and constructed self-identified neighborhood boundary definitions. Finally, this study collected both perceived neighborhood characteristics and objective neighborhood conditions to create a comprehensive, flexible and rich neighborhood-level set of covariates. This research revealed that men perceived their home, social and sexual neighborhoods in different ways. Few men (15%) had the same home, social and sexual neighborhoods; for 31%, none of the neighborhoods was the same. Of the three types of neighborhoods, the number of unique social neighborhoods was the lowest; the size of sexual neighborhoods was the smallest. The resultant dataset offers the opportunity to conduct analyses that will yield context-specific and nuanced understandings of the relations among neighborhood space, and the well-being and health of urban MSM.

Kurtz, S. P., Stall, R. D., Buttram, M. E., Surratt, H. L., & Chen, M. (2013). A Randomized Trial of a Behavioral Intervention for High Risk Substance-Using MSM. AIDS Behav, 17(9), 2914-2926. doi: 10.1007/s10461-013-0531-z

Substance-using men who have sex with men (MSM) are among the groups at highest risk for HIV infection in the United States. We report the results of a randomized trial testing the efficacy of a small group sexual and substance use risk reduction intervention based on empowerment theory compared to an enhanced efficacious control condition among 515 high risk not-in-treatment MSM substance users. Effect sizes for sexual risk and substance use outcomes were moderate to large: HIV transmission risk frequency, d = 0.71 in the control versus 0.66 in the experimental group; number of anal sex partners, d = 1.04 versus 0.98; substance dependence symptoms, d = 0.49 versus 0.53; significant differences were not observed between conditions. Black MSM reduced their risks at a greater rate than White or Latino men. The findings point to a critically important research agenda to reduce HIV transmission among MSM substance users.

 Lee, J. G., Agnew-Brune, C. B., Clapp, J. A., & Blosnich, J. R. (2013). Out smoking on the big screen: tobacco use in LGBT movies, 2000-2011. Tob Control. doi: 10.1136/tobaccocontrol-2013-051288

Lesbian, gay, bisexual and transgender (LGBT) people have significantly higher smoking prevalence than heterosexual people in the USA. The reasons for this disparity remain unclear. Tobacco use in movies has a substantial influence on tobacco use behaviours, particularly among youth. Yet, no research has examined tobacco use in movies for LGBT audiences or containing LGBT characters. METHODS: We identified 81 US movies from 2000 to 2011 with a theatre release and with LGBT themes or characters. We then selected a random sample of these movies (n=45) for quantitative content analysis to examine the proportion of movies with depictions of tobacco use and the number of occurrences of tobacco use. RESULTS: Tobacco use was depicted in 87% (95% CI 80% to 94%) of movies with an average of four occurrences of tobacco use per hour (95% CI 3 to 5). Only 15% (95% CI 8% to 23%) of movies and 3% of all depictions of tobacco use conveyed any harms of tobacco use. CONCLUSIONS: Viewers of movies with LGBT themes or characters are exposed, on average, to one depiction of tobacco use for every 15 min of movie run-time. As a major component of the entertainment media environment, movies may contribute to smoking among LGBT people.

Lim, S. H., Bazazi, A. R., Sim, C., Choo, M., Altice, F. L., & Kamarulzaman, A. (2013). High rates of unprotected anal intercourse with regular and casual partners and associated risk factors in a sample of ethnic Malay men who have sex with men (MSM) in Penang, Malaysia. Sex Transm Infect, 89(8), 642-649. doi: 10.1136/sextrans-2012-050995

To assess the prevalence of unprotected anal intercourse (UAI) and its correlates among ethnic Malay men who have sex with men (MSM). METHODS: In 2010, a convenience sample of 350 MSM in Penang were recruited to participate in an anonymous, computerised survey with rapid HIV testing. Participants who were not of Malay ethnicity (n=44) or who did not report sex with another man in the previous 12 months (n=22) were excluded, resulting in 284 participants in the final analysis. Correlates of UAI were examined separately for regular and casual partnerships using bivariate and multivariate logistic regression. RESULTS: Four men (1.9%) tested HIV positive. In the past 12 months, 64.7% of participants had regular sexual partners, 77.1% had casual sexual partners and 41.9% had both. Most participants (83.1%) reported UAI, which was more common in regular partnerships. Over two-thirds of participants had never been tested for HIV. In multivariate analysis, agreement about sexual risk reduction practices was associated with a reduction in UAI with regular partners (adjusted OR (AOR)=0.14, 95% CI 0.05 to 0.40). Reporting difficulty in using condoms was associated with an increase in UAI with casual partners (AOR=9.07, 95% CI 3.35 to 24.5), and any exposure to HIV prevention was associated with a decrease in UAI with casual partners (AOR=0.22, 95% CI 0.09 to 0.54). CONCLUSIONS: Despite highly prevalent HIV risk behaviours, HIV seropositivity and prior HIV testing were low. Increasing sexual negotiation skills and access to HIV testing and other prevention services may improve future prevention efforts.

Marshal, M. P., Burton, C. M., Chisolm, D. J., Sucato, G. S., & Friedman, M. S. (2013). Cross-sectional evidence for a stress-negative affect pathway to substance use among sexual minority girls. Clin Transl Sci, 6(4), 321-322. doi: 10.1111/cts.12052

Sexual minority girls (SMGs) are four times more likely to engage in substance use than are heterosexual girls. A better understanding of the explanatory mechanisms of this disparity is needed to inform prevention and intervention programs. The goal of this study was to conduct a preliminary test of a “stress-negative affect” pathway by examining gay-related victimization and depression as mediators of substance use among SMGs. Adolescent girls (N = 156, 41% SMGs) were recruited from two urban adolescent medicine clinics to participate in an NIH-funded study of adolescent substance use. The average age was 17.0 years old and 57% were nonwhite. Mediation analyses were conducted in a multiple regression framework using SPSS and a mediation macro utilizing bias-corrected bootstrapping. Four models were estimated to test mediated pathways from sexual orientation to gay-related victimization (Mediator 1), to depression symptoms (Mediator 2), and then to each of four substance use variables: cigarettes, marijuana, alcohol, and heavy alcohol use. Significant mediated pathways (mediation tests with 95% CIs) were found for cigarette, alcohol and heavy alcohol use outcome variables. Results provide preliminary support for the minority stress hypothesis and the stress-negative affect pathway, and may inform the development of future prevention and intervention programs.

Marshal, M. P., Dermody, S. S., Cheong, J., Burton, C. M., Friedman, M. S., Aranda, F., & Hughes, T. L. (2013). Trajectories of depressive symptoms and suicidality among heterosexual and sexual minority youth. J Youth Adolesc, 42(8), 1243-1256. doi: 10.1007/s10964-013-9970-0

Sexual minority youth report higher rates of depression and suicidality than do heterosexual youth. Little is known, however, about whether these disparities continue as youth transition into young adulthood. The primary goals of this study were to describe and compare trajectories of adolescent depressive symptoms and suicidality among sexual minority and heterosexual youth, examine differences in depressive symptoms and suicidality trajectories across sexual orientation subgroups, and determine whether there are gender differences in these longitudinal disparities. Four waves of data from the National Longitudinal Study of Adolescent Health were analyzed using latent curve modeling (N = 12,379; 53% female). Results showed that the rates of depressive symptoms and suicidality in early adolescence were higher among sexual minority youth than among heterosexual youth, and that these disparities persisted over time as participants transitioned into young adulthood. Consistent with previous cross-sectional studies, the observed longitudinal disparities were largest for females and for bisexually-identified youth. Sexual minority youth may benefit from childhood and early adolescent prevention and intervention programs.

Marshal, M. P., Dermody, S. S., Shultz, M. L., Sucato, G. S., Stepp, S. D., Chung, T., . . . Hipwell, A. E. (2013). Mental health and substance use disparities among urban adolescent lesbian and bisexual girls. J Am Psychiatr Nurses Assoc, 19(5), 271-279. doi: 10.1177/1078390313503552

Sexual minority girls (SMGs) report large substance use disparities and victimization experiences, yet there is a dearth of research that focuses exclusively on SMGs. OBJECTIVE: To examine substance use and mental health disparities among SMGs and to determine whether disparities were larger for African American compared with European American girls. METHOD: Data were used from Wave 11 of the Pittsburgh Girls Study, a multiple-cohort, prospective study of urban girls. Girls for the current analysis were aged 16 to 19 years. Fifty-five percent were African American. One hundred and seventy-three (8.3%) identified as SMGs, and 1,891 identified as heterosexual. Multiple regression analyses controlling for age, race, and parent education were conducted. RESULTS: SMGs reported a robust pattern of large disparities in externalizing, internalizing, and borderline personality disorder symptoms. There was little evidence to suggest disparities were moderated by race. CONCLUSION: SMGs and their families would benefit from intervention and prevention programs to reduce disparities among this highly vulnerable population.

McGowan, I. (2013). The development of rectal microbicides for HIV prevention. Expert Opin Drug Deliv. doi: 10.1517/17425247.2013.860132

Individuals practicing unprotected receptive anal intercourse are at particularly high risk of HIV infection. Men who have sex with men in the developed and developing world continue to have disproportionate and increasing levels of HIV infection. The last few years have seen important progress in demonstrating the efficacy of oral antiretroviral pre-exposure prophylaxis, vaginal microbicides, and treatment as prevention, but there has also been significant progress in the development of rectal microbicides for HIV prevention. Areas covered: The purpose of this review is to summarize the status of rectal microbicide research and to identify opportunities, challenges, and future directions in this important field of HIV prevention research. The design of completed and ongoing Phase I rectal microbicide studies that include the generation of comprehensive pharmacokinetic/pharmacodynamic data may allow for more rational decisions about which rectal microbicides should be advanced to later stage development. Expert opinion: There is a strong rationale for the development of rectal microbicides for HIV prevention. Preclinical data provide supportive evidence for the feasibility of this approach, and there is significant interest in rectal microbicide development from communities at risk of HIV acquisition through unprotected receptive anal intercourse in both the developed and developing world. Demonstration of sustained safety, acceptability, and product adherence in the MTN-017 Phase II study of tenofovir 1% gel will be an important step in rectal microbicide development and will hopefully lead to Phase III effectiveness testing of this novel HIV prevention strategy.

Ng, K. T., Ong, L. Y., Lim, S. H., Takebe, Y., Kamarulzaman, A., & Tee, K. K. (2013). Evolutionary history of HIV-1 subtype B and CRF01_AE transmission clusters among men who have sex with men (MSM) in Kuala Lumpur, Malaysia. PLoS One, 8(6), e67286. doi: 10.1371/journal.pone.0067286

HIV-1 epidemics among men who have sex with men (MSM) continue to expand in developed and developing countries. Although HIV infection in MSM is amongst the highest of the key affected populations in many countries in Southeast Asia, comprehensive molecular epidemiological study of HIV-1 among MSM remains inadequate in the region including in Malaysia. Here, we reported the phylodynamic profiles of HIV-1 genotypes circulating among MSM population in Kuala Lumpur, Malaysia. A total of n = 459 newly-diagnosed treatment-naive consenting subjects were recruited between March 2006 and August 2012, of whom 87 (18.9%) were self-reported MSM. Transmitted drug resistance mutations were absent in these isolates. Cumulatively, phylogenetic reconstructions of the pro-rt gene (HXB2ratio2253-3275) showed that HIV-1 subtype B and CRF01_AE were predominant and contributed to approximately 80% of the total HIV-1 infection among MSM. In addition to numerous unique transmission lineages within these genotypes, twelve monophyletic transmission clusters of different sizes (2-7 MSM sequences, supported by posterior probability value of 1) were identified in Malaysia. Bayesian coalescent analysis estimated that the divergence times for these clusters were mainly dated between 1995 and 2005 with four major transmission clusters radiating at least 12 years ago suggesting that active spread of multiple sub-epidemic clusters occurred during this period. The changes in effective population size of subtype B showed an exponential growth within 5 years between 1988 and 1993, while CRF01_AE lineage exhibited similar expansion between 1993 and 2003. Our study provides the first insight of the phylodynamic profile of HIV-1 subtype B and CRF01_AE circulating among MSM population in Kuala Lumpur, Malaysia, unravelling the importance of understanding transmission behaviours as well as evolutionary history of HIV-1 in assessing the risk of outbreak or epidemic expansion.

Sander, P. M., Cole, S. R., Stall, R. D., Jacobson, L. P., Eron, J. J., Napravnik, S., . . . Ostrow, D. G. (2013). Joint effects of alcohol consumption and high-risk sexual behavior on HIV seroconversion among men who have sex with men. AIDS, 27(5), 815-823. doi: 10.1097/QAD.0b013e32835cff4b

To estimate the effects of alcohol consumption and number of unprotected receptive anal intercourse partners on HIV seroconversion while appropriately accounting for time-varying confounding. DESIGN: Prospective cohort of 3725 HIV-seronegative men in the Multicenter AIDS Cohort Study between 1984 and 2008. METHODS: Marginal structural models were used to estimate the joint effects of alcohol consumption and number of unprotected receptive anal intercourse partners on HIV seroconversion. RESULTS: Baseline self-reported alcohol consumption was a median 8 drinks/week (quartiles: 2, 16), and 30% of participants reported multiple unprotected receptive anal intercourse partners in the prior 2 years. Five hundred and twenty-nine HIV seroconversions occurred over 35 ,870 person-years of follow-up. After accounting for several measured confounders using a joint marginal structural Cox proportional hazards model, the hazard ratio for seroconversion associated with moderate drinking (1-14 drinks/week) compared with abstention was 1.10 [95% confidence limits: 0.78, 1.54] and for heavy drinking (>14 drinks/week) was 1.61 (95% confidence limits: 1.12, 2.29) (P for trend <0.001). The hazard ratios for heavy drinking compared with abstention for participants with 0-1 or more than 1 unprotected receptive anal intercourse partner were 1.37 (95% confidence limits: 0.88, 2.16) and 1.96 (95% confidence limits: 1.03, 3.72), respectively (P for interaction = 0.42). CONCLUSION: These findings suggest that alcohol interventions to reduce heavy drinking among men who have sex with men should be integrated into existing HIV prevention activities.

Silvestre, A., Beatty, R. L., & Friedman, M. R. (2013). Substance use disorder in the context of LGBT health: a social work perspective. Soc Work Public Health, 28(3-4), 366-376. doi: 10.1080/19371918.2013.774667

The impacts of public and private funding of lesbian, gay, bisexual, and transgender (LGBT) health research, the state of integration of LGBT health issues into the academic and professional training programs of health care practitioners, and the larger social reality experienced by LGBT people profoundly affect substance use and substance use disorders in those populations. This analysis uses a social work perspective and considers the current state of research, professional training, and social oppression as they affect the health of LGBT people. Suggestions for action are offered that may improve the health of LGBT peoples and the practice of social work.

Sohler NL, Weiss L, Egan JE, Lopez CM, Favaro J, Cordero R, Cunningham CO.  (2013) Consumer attitudes about opioid addiction treatment: A focus group study in New York City. Journal of Opioid Management 9(2):111-9. PMID: 23709320

To develop effective programs for people who are opioid dependent and to impact the opioid epidemic in New York City, it is crucial to monitor attitudes about opioid addiction treatments among opioid users who have experienced barriers to engagement and retention in addiction treatment. Design: The authors conducted a qualitative study using focus groups. Methods: Six focus groups in three needle exchanges in New York City were audio recorded, transcribed, and systematically coded. The authors report on the main themes related to the study objectives. Participants: Participants of each needle exchange who were opioid dependent and had some knowledge of both methadone and buprenorphine were eligible. Results: There were four main findings. Participants felt the following: 1) buprenorphine is an appropriate option for those heroin users who are motivated to stop using, 2) they have less control over their addiction treatment with methadone than they would have with buprenorphine, 3) buprenorphine treatment is not accessible to many New York City residents who would benefit from this treatment, and 4) lack of access to buprenorphine treatment is a cause of treatment-related diversion. Conclusions: Both methadone maintenance and buprenorphine treatment opportunities are necessary to address the diverse treatment needs of opioid dependent people in New York City. However, the current medical model of buprenorphine treatment may be too restrictive for some opioid-dependent people and may be contributing to the use of illicit buprenorphine. New models to deliver buprenorphine treatment may address these problems.

Wei, C., Lim, S. H., Guadamuz, T. E., & Koe, S. (2013). Virtual Versus Physical Spaces: Which Facilitates Greater HIV Risk Taking Among Men Who Have Sex with Men in East and South-East Asia? AIDS Behav. doi: 10.1007/s10461-013-0628-4

Increasing use of the Internet to seek sex partners is accompanied by rising HIV infections among men who have sex with men (MSM) in East and South-East Asia. We examined whether the Internet facilitates greater HIV risk taking among MSM in the region. A cross-sectional sample of 9,367 MSM was recruited via the Internet in 2010. We compared socio-demographic and HIV-related behavioral characteristics among MSM who met sex partners on the Internet only, who met sex partners offline only, and who met sex partners through both. Multinomial logistic regression was used to identify independent correlates that were associated with differences in where participants met their male sex partners. Compared to MSM who met partners offline only, those who met partners online only were less likely to have multiple male sex partners, have paid for sex, have consumed recreational drugs, and have used alcohol before sex. MSM who met partners both online and offline appeared to be the riskiest group that they were more likely to have multiple male sex partners, have engaged in UIAI, and have consumed alcohol before sex. These findings suggest that social networking websites alone do not facilitate greater HIV risk taking among MSM. Rather, they provide additional venues for MSM who already engage in HIV-related high risk behaviors to seek sex partners. The Internet offers incredible opportunities to reach large numbers of MSM in East and South-East Asia for HIV prevention and research. Web-based outreach and prevention activities are needed to reach these men. In addition, mobile and application-based interventions should also be developed and disseminated.

Wei, C., Yan, H., Yang, C., Raymond, H. F., Li, J., Yang, H., . . . Stall, R. (2013). Accessing HIV testing and treatment among men who have sex with men in China: A qualitative study. AIDS Care. doi: 10.1080/09540121.2013.824538

Barriers to HIV testing and HIV care and treatment pose significant challenges to HIV prevention among men who have sex with men (MSM) in China. We carried out a qualitative study to identify barriers and facilitators to HIV testing and treatment among Chinese MSM. In 2012, seven focus group (FG) discussions were conducted with 49 MSM participants in Nanjing, China. Purposive sampling was used to recruit a diverse group of MSM participants. Semi-structured interviews were conducted to collect FG data. Major barriers to testing included gay- and HIV-related stigma and discrimination, relationship type and partner characteristics, low perception of risk or threat, HIV is incurable or equals death, concerns of confidentiality, unaware that testing is offered for free, and name-based testing. Key facilitators of testing included engaging in high-risk sex, sense of responsibility for partner, collectivism, testing as a part of standard/routine medical care, MSM-friendly medical personnel, increased acceptance of gay/bisexual men by the general public, legal recognition and protection of homosexuals, and home self-testing. Barriers to treatment included negative coping, nondisclosure to families, misconceptions of domestically produced antiretroviral drugs (ARVs) and the benefits of treatment, and costs associated with long-term treatment. Facilitators of treatment included sense of hopefulness that a cure would be found, the cultural value of longevity, peer social support and professional psychological counseling, affordable and specialized treatment and care, and reduced HIV-related stigma and discrimination. Finally, for both testing and treatment, more educational and promotional activities within MSM communities and among the general public are needed.

Wiley, D. J., Li, X., Hsu, H., Seaberg, E. C., Cranston, R. D., Young, S., . . . Detels, R. (2013). Factors Affecting the Prevalence of Strongly and Weakly Carcinogenic and Lower-Risk Human Papillomaviruses in Anal Specimens in a Cohort of Men Who Have Sex with Men (MSM). PLoS One, 8(11), e79492. doi: 10.1371/journal.pone.0079492

MSM are at higher risk for invasive anal cancer. Twelve human papillomaviruses (HPVs) cause cervical cancer in women (Group 1 high-risk HPVs (hrHPVs)) and 13 HPVs are probable/possible causes (Group 2 hrHPVs) of cervical malignancy. HPVs rarely associated with malignancy are classified as lower-risk HPVs (lrHPVs). MATERIALS AND METHODS: Dacron-swab anal-cytology specimens were collected from and data complete for 97% (1262/1296) of Multicenter AIDS Cohort Study (MACS) men tested for HPVs using the Linear Array assay. Multivariate Poisson regression analyses estimated adjusted prevalence ratios for Group 1/2 hrHPVs and lrHPVs, controlling for the effects of age, race, ethnicity, sexual partnerships, smoking; HIV-infection characteristics, treatment, and immune status among HIV-infected men. RESULTS: HIV-infected men showed 35-90% higher prevalence of Group 1/2 hrHPVs and lrHPVs than HIV-uninfected men, and higher prevalence of multi-Type, and multiple risk-group infections. CD4+ T-cell count was inversely associated with HPV Group 2 prevalence (p<0.0001). The number of receptive anal intercourse (RAI) partners reported in the 24 months preceding HPV testing predicted higher prevalence of Group 1/2 hrHPVs. Men reporting >/=30 lifetime male sex partners before their first MACS visit and men reporting >/=1 RAI partners during the 24 months before HPV testing showed 17-24% and 13-17% higher prevalence of lrHPVs (p-values </=0.05). Men reporting smoking between MACS visit 1 and 24 months before HPV testing showed 1.2-fold higher prevalence of Group 2 hrHPVs (p = 0.03). Both complete adherence to CART (p = 0.02) and HIV load <50 copies/mL (p = 0.04) were protective for Group 1 hrHPVs among HIV-infected men. CONCLUSIONS: HIV-infected men more often show multi-type and multi-group HPV infections HIV-uninfected men. Long-term mutual monogamy and smoking cessation, generally, and CART-adherence that promotes (HIV) viremia control and prevents immunosuppression, specifically among HIV-infected MSM, are important prevention strategies for HPV infections that are relevant to anal cancer.

Yan, H., Yang, H., Li, J., Wei, C., Xu, J., Liu, X., . . . McFarland, W. (2013). Emerging Disparity in HIV/AIDS Disease Progression and Mortality for Men Who Have Sex with Men, Jiangsu Province, China. AIDS Behav. doi: 10.1007/s10461-013-0520-2

Few data exist on HIV disease progression and antiretroviral treatment (ART) impact among men who have sex with men (MSM) in China. Using data from the national case reporting system from 2004 to 2010, we describe changes in CD4 cell count before and after ART initiation, disease progression, and mortality among MSM in Jiangsu province compared with other persons living with HIV/AIDS. Median CD4 cell count among MSM at HIV diagnosis was 432 and decreased rapidly in 12 months to below the level of heterosexuals (slope: MSM -38.0, heterosexuals -15.5, injection drug users [IDU] -8.0, blood donors -10.5). Among those initiating ART, median CD4 cell count among MSM was 157, yet the increase in count was slower than for other groups (slope: MSM 26.9, heterosexuals 31.9, IDU 29.0, blood donors 35.0). Progression to AIDS was faster among MSM than heterosexuals and IDU. For the present, the mortality rate was lower for MSM compared with heterosexuals and blood donors; however, against a backdrop of more recent infection (ie, MSM had younger age, and 93.8 % were diagnosed after 2008), findings suggest a survival rate for MSM that will fall behind other groups. Improved medical and psychosocial supportive care is needed for this stigmatized population lest disparities become greater.

Yang, D., Chariyalertsak, C., Wongthanee, A., Kawichai, S., Yotruean, K., Saokhieo, P., . . . Chariyalertsak, S. (2013). Acceptability of Pre-Exposure Prophylaxis among Men Who Have Sex with Men and Transgender Women in Northern Thailand. PLoS One, 8(10), e76650. doi: 10.1371/journal.pone.0076650

Northern Thailand has a high burden HIV epidemic among MSM and TG. Oral pre-exposure prophylaxis (PrEP) with tenofovir-emtricitabine has demonstrated efficacy in preventing HIV among MSM and TG in Chiang Mai, Thailand. Determinants of PrEP acceptability are needed to gauge the potential uptake of this prevention strategy. METHODS: From January to February 2012, 238 MSM and TG participants, who self-reported as HIV-uninfected or of unknown status, completed a self-administered survey on hand-held computers. Participants were recruited by venue-day-time sampling and asked to rate their likelihood of using oral PrEP for HIV prevention with an efficacy of 50%. PrEP acceptability was defined as being “very likely” to use PrEP. Odds ratios and 95% CIs were calculated to identify correlates of acceptability. RESULTS: 131 MSM and 107 TG responded, with mean ages of 23.7 and 21.8, respectively. 24% of MSM engaged primarily in receptive anal sex vs. 74% of TG. 21% of MSM and 44% of TG reported regular medication use. Prior awareness of PrEP was high at 66% among both MSM and TG respondents. 41% of MSM and 37% of TG were “very likely” to use PrEP. Among MSM, factors associated with PrEP acceptability included a prior history of STIs (AOR 4.6; 95%CIs 1.7-12.6), previous HIV testing (AOR 2.4 95%CIs 1.1-5.3), regularly planned sex (AOR 2.8 95%CIs 1.1-7.2), and infrequent sex (AOR 2.9 95%CIs 1.3-6.3). Among TG, factors associated with acceptability included prior awareness of PrEP (AOR 3.3; 95%CIs 1.2-9.0) and having private insurance (AOR 5.0; 95%CIs 1.3-19.0). CONCLUSION: MSM and TG in Northern Thailand are distinct groups in terms of sexual behaviors, patterns of medication use, and correlates of PrEP acceptability. Efforts to maximize PrEP uptake should include expanded HIV testing services and the provision of financial subsidies to reduce the cost of PrEP.

Zou, C., Andersen, J. P., & Blosnich, J. R. (2013). The association between bullying and physical health among gay, lesbian, and bisexual individuals. J Am Psychiatr Nurses Assoc, 19(6), 356-365. doi: 10.1177/1078390313510739

Research suggests that lesbian, gay, and bisexual (LGB) populations experience higher prevalence of school bullying than heterosexuals. Objectives: We examined if (a) verbal versus physical bullying were differentially associated with physical health among sexual minorities and (b) if sexual identity (i.e., homosexual [i.e., lesbian/gay] vs. bisexual) moderated the association of bullying on physical health. Design: LGB adults aged 18 to 66 years (n = 463) were recruited online. Participants reported high school experiences of verbal and physical bullying and physician-diagnosed health conditions. Results: Physical and verbal bullying were related to physical health conditions (ps < .01). Physical bullying had a significant negative impact on physical health for bisexual persons (p < .001) but not for gay/lesbian persons. Conclusions: Experiencing bullying in high school was associated with physical health problems in adulthood. Bullying had a different relationship with health problems for bisexually identified individuals compared to lesbian/gay individuals. Future research should strive to disentangle potential differences in the relationship between bullying and health within sexual minority groups.

 

2012

Carrico, A. W., Pollack, L. M., Stall, R. D., Shade, S. B., Neilands, T. B., Rice, T. M., Moskowitz, J. T. (2012). Psychological processes and stimulant use among men who have sex with men. Drug Alcohol Depend, 123(1-3), 79-83. doi: 10.1016/j.drugalcdep.2011.10.020

Prior research established that psychological factors are associated with the frequency of stimulant (i.e., cocaine, crack, and methamphetamine) use among substance-using men who have sex with men (MSM). The present investigation examined whether and how psychological factors are associated with engagement in any stimulant use in the broader population of MSM. METHODS: A probability sample of 879 MSM residing in San Francisco was obtained using random digit dialing from May of 2002 through January of 2003. Of these, 711 participants (81%) completed a mail-in questionnaire that assessed psychological factors and substance use. After accounting for demographic factors, a multiple logistic regression analysis examined correlates of any self-reported stimulant use during the past 6 months. Path analyses examined if the use of alcohol or other substances to avoid negative mood states (i.e., substance use coping) mediated the associations of sexual compulsivity and depressed mood with stimulant use. RESULTS: Younger age (adjusted OR [AOR]=0.58; 95% CI=0.47-0.70), HIV-positive serostatus (AOR=2.55; 95% CI=1.61-4.04), greater depressed mood (AOR=1.26; 95% CI=1.05-1.52) and higher sexual compulsivity (AOR=1.46; 95% CI=1.18-1.80) were independently associated with increased odds of stimulant use. Substance use coping partially mediated the associations of sexual compulsivity (beta(indirect)=0.11, p<.001) and depressed mood (beta(indirect)=0.13, p<.001) with stimulant use. CONCLUSIONS: Clinical research is needed to examine if interventions targeting sexual compulsivity and emotion regulation reduce stimulant use among MSM.

Cranston, R. D., Murphy, R., Weiss, R. E., Da Costa, M., Palefsky, J., Shoptaw, S., & Gorbach, P. M. (2012). Anal human papillomavirus infection in a street-based sample of drug using HIV-positive men. Int J STD AIDS, 23(3), 195-200. doi: 10.1258/ijsa.2011.011169

HIV facilitates an increase in human papillomavirus (HPV)-associated conditions. HIV-positive men living in a substance use context in Los Angeles, USA, were recruited using respondent-driven sampling, completed a questionnaire and had biological samples including an anal HPV swab taken. A total of 316 evaluable men were enrolled in the study. The prevalence of any HPV, high-risk (HR) infection and multiple-type infection was highest for men who have sex with men (MSM) (93.9%, 64.6% and 29.7%, respectively). When any HPV and HR-HPV prevalence in all men was stratified by age, the youngest group had 100% and 68.2% prevalence, respectively, with similarly high rates maintained up to age 49 years. The individual’s use of alcohol, marijuana, cocaine, methamphetamine or heroin was not significantly associated with anal HPV detection. In this marginalized population, high prevalence rates of anal HPV and HR-HPV occurring over a wide age range may increase the individual’s risk for anal dysplasia and anal cancer.

 Dyer, T. P., Shoptaw, S., Guadamuz, T. E., Plankey, M., Kao, U., Ostrow, D., Stall, R. (2012). Application of syndemic theory to black men who have sex with men in the Multicenter AIDS Cohort Study. J Urban Health, 89(4), 697-708. doi: 10.1007/s11524-012-9674-x

This study analyzed data from a large prospective epidemiologic cohort study among men who have sex with men (MSM), the Multicenter AIDS Cohort Study, to assess syndemic relationships among black MSM in the cohort (N = 301). We hypothesized that multiple interconnections among psychosocial health PubMed CLGBTHR author search update Jan 01 2012 through Dec 31 2012 2 conditions would be found among these men, defining syndemic conditions. Constituents of syndemic conditions measured included reported depression symptoms, sexual compulsiveness, substance use, intimate partner violence (IPV), and stress. We found significant evidence of syndemics among these black men: depression symptoms were independently associated with sexual compulsiveness (odds ratios [OR]: 1.88, 95% CI = 1.1, 3.3) and stress (OR: 2.67, 95% CI = 1.5, 4.7); sexual compulsiveness was independently associated with stress (OR: 2.04, 95% CI = 1.2, 3.5); substance misuse was independently associated with IPV (OR: 2.57, 95% CI = 1.4, 4.8); stress independently was associated with depression symptoms (OR: 2.67, 95% CI = 1.5, 4.7), sexual compulsiveness (OR: 2.04, 95% CI = 1.2, 3.5) and IPV (OR: 2.84, 95% CI = 1.6, 4.9). Moreover, men who reported higher numbers of syndemic constituents (three or more conditions) reportedly engaged in more unprotected anal intercourse compared to men who had two or fewer health conditions (OR: 3.46, 95% CI = 1.4-8.3). Findings support the concept of syndemics in black MSM and suggest that syndemic theory may help explain complexities that sustain HIV-related sexual transmission behaviors in this group.

Guadamuz, T. E., Lim, S. H., Marshal, M. P., Friedman, M. S., Stall, R. D., & Silvestre, A. J. (2012). Sexual, behavioral, and quality of life characteristics of healthy weight, overweight, and obese gay and bisexual men: findings from a prospective cohort study. Arch Sex Behav, 41(2), 385-389. doi: 10.1007/s10508-011-9859-5

While there have been attempts to explore the association of obesity and risky sexual behaviors among gay men, findings have been conflicting. Using a prospective cohort of gay and bisexual men residing in Pittsburgh, we performed a semi-parametric, group-based analysis to identify distinct groups of trajectories in body mass index slopes over time from 1999 to 2007 and then correlated these trajectories with a number of psychosocial and behavioral factors, including sexual behaviors. We found many men were either overweight (41.2%) or obese (10.9%) in 1999 and remained stable at these levels over time, in contrast to recent increasing trends in the general population. Correlates of obesity in our study replicated findings from the general population. However, we found no significant association between obesity and sexual risk-taking behaviors, as suggested from several cross-sectional studies of gay men. While there was not a significant association between obesity and sexual risk-taking behaviors, we found high prevalence of overweight and obesity in this population. Gay and bisexual men’s health researchers and practitioners need to look beyond HIV and STI prevention and also address a broader range of health concerns important to this population.

Hart, T. A., Moskowitz, D., Cox, C., Li, X., Ostrow, D. G., Stall, R. D., Plankey, M. (2012). The cumulative effects of medication use, drug use, and smoking on erectile dysfunction among men who have sex with men. J Sex Med, 9(4), 1106-1113. doi: 10.1111/j.1743-6109.2011.02648.x

Erectile dysfunction (ED) is highly prevalent among human immunodeficiency virusseropositive (HIV+) men who have sex with men (MSM). There is a need for additional research to determine the correlates of HIV+ and HIV-seronegative (HIV-) MSM, especially regarding nonantiretroviral medication use. AIMS: This study examined the prevalence of ED and the sociodemographic, medical conditions, medication use, and substance use correlates of ED among HIV+ and HIV- MSM. METHODS: A modified version of the International Index of Erectile Function (IIEF) for MSM was self-administered by participants enrolled in the Multicenter AIDS Cohort Study, an ongoing prospective study of the natural and treated histories of HIV infection among MSM in the PubMed CLGBTHR author search update Jan 01 2012 through Dec 31 2012 3 United States. The study sample included 1,340 participants, including 612 HIV+ and 728 HIV- men. Poisson regression with robust error variance was used to estimate prevalence ratios of ED in multivariable models in combined (HIV+/-) and separate analyses. MAIN OUTCOME MEASURE: ED was determined by the summed scores of a modified version of the IIEF validated among MSM. RESULTS: Twenty-one percent of HIV+ MSM and 16% of HIV- MSM reported ED. Being >55 years of age, black race, cumulative pack years of smoking, cumulative antihypertensive use, and cumulative antidepressant use had significant positive associations with the prevalence of ED in the total sample. Among HIV+ men, duration of antihypertensive use and antidepressant use were significantly associated with increasing prevalence of ED. Among HIV- men, being >55 years of age, black race, and cigarette smoking duration were associated with increased prevalence of ED. CONCLUSION: Predictors of ED may differ by HIV status. Although smoking cessation and effective medication management may be important as possible treatment strategies for ED among all MSM, there may be a burden on sexual functioning produced by non-HIV medications for HIV+ men.

Herrick, A. L., Lim, S. H., Plankey, M. W., Chmiel, J. S., Guadamuz, T. T., Kao, U., Stall, R. (2012). Adversity and Syndemic Production Among Men Participating in the Multicenter AIDS Cohort Study: A Life-Course Approach. Am J Public Health. doi: 10.2105/ajph.2012.300810

We tested a theory of syndemic production among men who have sex with men (MSM) using data from a large cohort study. Methods. Participants were 1551 men from the Multicenter AIDS Cohort Study enrolled at 4 study sites: Baltimore, Maryland-Washington, DC; Chicago, Illinois; Los Angeles, California; and Pittsburgh, Pennsylvania. Participants who attended semiannual visits from April 1, 2008, to March 31, 2009, completed an additional survey that captured data about events throughout their life course thought to be related to syndemic production.  Results: Using multivariate analysis, we found that the majority of life-course predictor variables (victimization, internalized homophobia, etc.) were significantly associated with both the syndemic condition and the component psychosocial health outcomes (depressive symptoms, stress, stimulant use, sexual compulsivity, intimate partner violence). A nested negative binomial analysis showed that the overall life course significantly explained variability in the syndemic outcomes (chi(2) = 247.94; P < .001; df = 22). Conclusions: We identified life-course events and conditions related to syndemic production that may help to inform innovative interventions that will effectively disentangle interconnecting health problems and promote health among MSM.

Koblin, B. A., Bonner, S., Powell, B., Metralexis, P., Egan, J. E., Patterson, J., Spikes, P. (2012). A randomized trial of a behavioral intervention for black MSM: the DiSH study. AIDS, 26(4), 483-488. doi: 10.1097/QAD.0b013e32834f9833

To test a new behavioral intervention for black MSM in reducing sexual risk and increasing social support and intentions to use condoms. DESIGN: A single-site, unblinded randomized trial in New York City with 3-month follow-up. METHODS: Participants (n = 283) reporting at least two sexual partners and unprotected anal intercourse with a man in the past 3 months were enrolled and randomized to a social-cognitive theory-based intervention or control comparison. Men in the intervention group participated in five 2-h group sessions focused on creating a group environment with sexual risk-reduction information and exercises woven into joint meal preparation and sharing activities, while exploring self-efficacy perceptions and outcome expectancies. Intervention (n = 142) and control (n = 141) groups received standard HIV counseling and testing at baseline. RESULTS: No significant differences were found between study arms at 3 months in number of male partners, number of unprotected anal intercourse partners, proportion reporting unprotected sex, number of acts protected by condoms, self-efficacy, condom attitudes, condom intentions, social isolation and psychological distress. In both arms combined, declines from baseline to 3 months were observed in sexual risk behaviors, social isolation and psychological distress, whereas self-efficacy, condom attitudes and condom intentions improved. CONCLUSION: As the HIV epidemic continues to have a dramatic impact on black MSM in the USA, the urgency to design innovative interventions continues.

Kurtz, S. P., Buttram, M. E., Surratt, H. L., & Stall, R. D. (2012). Resilience, syndemic factors, and serosorting behaviors among HIV-positive and HIV-negative substance-using MSM. AIDS Educ Prev, 24(3), 193-205. doi: 10.1521/aeap.2012.24.3.193

Serosorting is commonly employed by MSM to reduce HIV risk. We hypothesize that MSM perceive serosorting to be effective, and that serosorting is predicted by resilience and inversely related to syndemic characteristics. Surveys included 504 substance-using MSM. Logistic regression models examined syndemic and resilience predictors of serosorting, separately by serostatus. For HIV-positive men, positive coping behaviors (P = .015) and coping self-efficacy (P = .014) predicted higher odds, and cognitive escape behaviors (P = .003) lower odds, of serosorting. For HIV-negative men, social engagement (P = .03) and coping self-efficacy (P = .01) predicted higher odds, and severe mental distress (P = .001), victimization history (P = .007) and cognitive escape behaviors (P = .006) lower odds, of serosorting. HIV-negative serosorters reported lower perceptions of risk for infection than nonserosorters (P < .000). Although high risk HIV-negative men may perceive serosorting to be effective, their high rates of UAI and partner change render this an ineffective risk reduction approach. Relevant public health messages are urgently needed.

Lim, S. H., Christen, C. L., Marshal, M. P., Stall, R. D., Markovic, N., Kim, K. H., & Silvestre, A. J. (2012). Middle-aged and older men who have sex with men exhibit multiple trajectories with respect to the number of sexual partners. AIDS Behav, 16(3), 590-598. doi: 10.1007/s10461-011-9916-z

This study aimed to examine trajectories with respect to the number of sexual partners among older men who have sex with men and to determine characteristics associated with trajectory groups. Nagin’s group based modeling was used to identify trajectories for 237 men from the Pitt Men’s Study with respect to the number of male intercourse partners from age 50.0 to 59.5. Three distinct trajectory groups were identified. Most men (69.2%) had a median of two sexual partners in the past 6 months across the age range of the study. A smaller group (19.4%) had low or no sex partners. The smallest group (11.4%) had 30 or more sexual partners in the past 6 months at age 50. The groups were statistically different with respect to race, HIV status, drug use (marijuana, poppers, crack cocaine, and Viagra), the number of unprotected anal sex partners, and personal attitudes towards sex.

Lim, S. H., Guadamuz, T. E., Wei, C., Chan, R., & Koe, S. (2012). Factors associated with unprotected receptive anal intercourse with internal ejaculation among men who have sex with men in a large Internet sample from Asia. AIDS Behav, 16(7), 1979-1987. doi: 10.1007/s10461-012-0233-y

We examined socio-demographic and behavioral characteristics of men who have sex with men (MSM) residing in Asia and correlates of unprotected receptive intercourse with Internet ejaculation (URAIE). Asia Internet MSM Sex Survey, a behavioral survey of MSM in Asia was conducted from 1 January to 28 February 2010. Data analysis was limited to participants aged 18 or above, biological male, and had one regular or casual sex partner in the past 6 months (n = 10,413). Pearson’s Chi-square test, t test and logistic regression were used to examine the correlates of URAIE in the past 6 months, the highest risk sexual behavior sampled. Of 7311 participants who had receptive anal intercourse, 47.5 % had URAIE, which was associated with the following attributes: less than high-school education and pre-college education compared to university (AOR = 1.53, 95 % CI: 1.28, 1.83; AOR = 1.22, CI: 1.08, 1.37), being in the heterosexual marriage (AOR = 1.35, CI: 1.18, 1.56), having regular partners or both regular and casual partners compared to having casual partners (AOR = 2.85, CI: 2.48, 3.27; AOR = 2.32, CI: 2.06, 2.62), HIV-positive compared to HIV-negative status (AOR = 1.39, 95 % CI: 1.08, 1.81), higher perception of HIV risk (AOR = 1.62, CI: 1.34, 1.95), use of recreational drug before sex (AOR = 1.30, CI: 1.14, 1.49), and use of the Internet as the main way to seek sex partners (AOR = 1.21, CI: 1.08, 1.36). MSM from certain Asian countries reported alarming rates of URAIE. The internet can be used as a platform for HIV surveillance and intervention.

Lim, S. H., Ostrow, D., Stall, R., Chmiel, J., Herrick, A., Shoptaw, S., Plankey, M. (2012). Changes in stimulant drug use over time in the MACS: evidence for resilience against stimulant drug use among men who have sex with men. AIDS Behav, 16(1), 151-158. doi: 10.1007/s10461-010-9866-x

Stimulant drug use is associated with numerous health problems among men who have sex with men (MSM). This paper describes how stimulant drug use changes over a four and one-half year period from 2003 until 2008. Participants were 2,389 men (17,222 person-visits) from The Multicenter AIDS Cohort Study (MACS)-an ongoing, prospective study of HIV infection among MSM. Group-based trajectory analyses of data from these men over the study period yielded a four groups solution: consistent users (9.8%), men whose use increased (5.4%), men whose use declined (6.9%), and abstinent or rarely-using men (77.9%). There were significant differences between groups in terms of demographic, behavioral risk and HIV serostatus. Men who increased or decreased stimulant drug use over time reported congruent changes in sexual risk taking. The fact that sexual risk levels parallel stimulant drug use over time suggests that finding ways to lower rates of stimulant drug use among MSM could be a tool in HIV prevention.

Marshal, M. P., King, K. M., Stepp, S. D., Hipwell, A., Smith, H., Chung, T., Markovic, N. (2012). Trajectories of alcohol and cigarette use among sexual minority and heterosexual girls. J Adolesc Health, 50(1), 97-99. doi: 10.1016/j.jadohealth.2011.05.008

To examine disparities between sexual minority girls (SMGs) and heterosexual girls in trajectories of substance use over time. METHOD: Girls were included in the analyses if they were 12-18 years of age at wave 1 and did not miss sexual orientation data at wave 4 (n = 7,765). Latent curve models were estimated across all four waves (extending from middle adolescence into young adulthood) to examine PubMed CLGBTHR author search update Jan 01 2012 through Dec 31 2012 6 trajectories of cigarette and alcohol use. RESULTS: Initial levels of substance use were higher for SMGs than they were for heterosexual girls. SMGs also exhibited sharper escalations in use across all substances over time as they were transitioning into young adulthood. CONCLUSIONS: Persistent rates of cigarette and heavy alcohol use among SMGs may increase their risk for a host of mental and physical health problems in adulthood. Clinicians should be prepared to discuss SMG health topics effectively and in private, and discuss prevention and intervention programs with girls at risk.

Marshal, M. P., Sucato, G., Stepp, S. D., Hipwell, A., Smith, H. A., Friedman, M. S., Markovic, N. (2012). Substance use and mental health disparities among sexual minority girls: results from the Pittsburgh girls study. J Pediatr Adolesc Gynecol, 25(1), 15-18. doi: 10.1016/j.jpag.2011.06.011

To examine substance use and mental health disparities between sexual minority girls and heterosexual girls. METHODS: Data from the Pittsburgh Girls Study were analyzed. All girls were 17 years old. Girls were included if they were not missing self-reported sexual orientation and mental health data (N = 527). Thirty-one girls (6%) endorsed same-sex romantic orientation/ identity or current same-sex attraction. Bivariate analyses were conducted to test group differences in the prevalence of substance use and suicidal behavior, and group differences in depression, anxiety, borderline personality disorder (BPD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms. RESULTS: Compared with heterosexual girls, sexual minority girls reported higher past-year rates of cigarette, alcohol, and heavy alcohol use, higher rates of suicidal ideation and self-harm, and higher average depression, anxiety, BPD, ODD, and CD symptoms. CONCLUSIONS: Sexual minority girls are an underrepresented group in the health disparities literature, and compared with heterosexual girls, they are at higher risk for mental health problems, most likely because of minority stress experiences such as discrimination and victimization. The disparities found in this report highlight the importance of discussing sexual orientation as part of a comprehensive preventive care visit.

 Mayer, K. H., Bekker, L. G., Stall, R., Grulich, A. E., Colfax, G., & Lama, J. R. (2012). Comprehensive clinical care for men who have sex with men: an integrated approach. Lancet, 380(9839), 378-387. doi: 10.1016/s0140-6736(12)60835-6

Men who have sex with men (MSM) have unique health-care needs, not only because of biological factors such as an increased susceptibility to infection with HIV and sexually transmitted infections associated with their sexual behaviour, but also because of internalisation of societal stigma related to homosexuality and gender non-conformity, resulting in depression, anxiety, substance use, and other adverse outcomes. Successful responses to the global HIV/AIDS epidemic will require the development of culturally sensitive clinical care programmes for MSM that address these health disparities and root causes of maladaptive behaviour (eg, societal homophobia). Health-care providers need to become familiar with local outreach agencies, hotlines, and media that can connect MSM with positive role models and social opportunities. Research is needed to understand how many MSM lead resilient and productive lives in the face of discrimination to develop assets-based interventions that build on community support. Optimum clinical care for sexual and gender minorities is a fundamental human right. MSM deserve to be treated with respect, and health-care providers need to interact with them in ways that promote disclosure of actionable health information.

McFarland, W., Chen, Y. H., Nguyen, B., Grasso, M., Levine, D., Stall, R., Raymond, H. F. (2012). Behavior, intention or chance? A longitudinal study of HIV seroadaptive behaviors, abstinence and condom use. AIDS Behav, 16(1), 121-131. doi: 10.1007/s10461-011-9936-8

Seroadaptive behaviors have been widely described as preventive strategies among men who have sex with men (MSM) and other populations worldwide. However, causal links between intentions to adopt seroadaptive behaviors and subsequent behavior have not been established. We conducted a longitudinal study of 732 MSM in San Francisco to assess consistency and adherence to multiple seroadaptive behaviors, abstinence and condom use, whether prior intentions predict future seroadaptive behaviors and the likelihood that observed behavioral patterns are the result of chance. Pure serosorting (i.e., having only HIV-negative partners) among HIV-negative MSM and seropositioning (i.e., assuming the receptive position during unprotected anal sex) among HIV-positive MSM were more common, more successfully adhered to and more strongly associated with prior intentions than consistent condom use. Seroconcordant partnerships occurred significantly more often than expected by chance, reducing the prevalence of serodiscordant partnerships. Having no sex was intended by the fewest MSM, yet half of HIV-positive MSM who abstained from sex at baseline also did so at 12 month follow-up. Nonetheless, no preventive strategy was consistently used by more than one-third of MSM overall and none was adhered to by more than half from baseline to follow-up. The effectiveness of seroadaptive strategies should be improved and used as efficacy endpoints in trials of behavioral prevention interventions.

McGowan, I. (2012). Rectal microbicide development. Curr Opin HIV AIDS, 7(6), 526-533. doi: 10.1097/COH.0b013e3283582bc2

Individuals practicing unprotected receptive anal intercourse are at particularly high risk of HIV infection. Men who have sex with men (MSM) in the developed and developing world continue to have disproportionate and increasing levels of HIV infection. The past few years have seen important progress in demonstrating the efficacy of oral pre-exposure prophylaxis (PrEP), vaginal microbicides, and treatment as prevention, but there has also been significant progress in the development of rectal microbicides. The purpose of this review is to summarize the status of rectal microbicide research and to identify opportunities, challenges, and future directions in this important field of HIV prevention. RECENT FINDINGS: Recent phase 1 rectal microbicide studies have characterized the safety, acceptability, compartmental pharmacokinetics, and pharmacodynamics of both UC781 and tenofovir gels. The tenofovir gel formulation used in vaginal studies was not well tolerated in the rectum and newer rectal-specific formulations have been developed and evaluated in phase 1 studies. SUMMARY: Complex phase 1 studies have provided important data on candidate rectal microbicides. Tenofovir gel is poised to move into phase 2 evaluation and it is possible that a phase 2B/3 effectiveness study could be initiated in the next 2-3 years.

Rueda, S., Raboud, J., Plankey, M., Ostrow, D., Mustard, C., Rourke, S. B., Silvestre, A. J. (2012). Labor Force Participation and Health-Related Quality of Life in HIV-Positive Men Who Have Sex with Men: The Multicenter AIDS Cohort Study. AIDS Behav, 16(8), 2350-2360. doi: 10.1007/s10461-012-0257-3

Too many people with HIV have left the job market permanently and those with reduced work capacity have been unable to keep their jobs. There is a need to examine the health effects of labor force participation PubMed CLGBTHR author search update Jan 01 2012 through Dec 31 2012 8 in people with HIV. This study presents longitudinal data from 1,415 HIV-positive men who have sex with men taking part in the Multicenter AIDS Cohort Study. Generalized Estimating Equations show that employment is associated with better physical and mental health quality of life and suggests that there may be an adaptation process to the experience of unemployment. Post hoc analyses also suggest that people who are more physically vulnerable may undergo steeper health declines due to job loss than those who are generally healthier. However, this may also be the result of a selection effect whereby poor physical health contributes to unemployment. Policies that promote labor force participation may not only increase employment rates but also improve the health of people living with HIV.

Sullivan, P. S., Carballo-Dieguez, A., Coates, T., Goodreau, S. M., McGowan, I., Sanders, E. J., Sanchez, J. (2012). Successes and challenges of HIV prevention in men who have sex with men. Lancet, 380(9839), 388-399. doi: 10.1016/s0140-6736(12)60955-6

Men who have sex with men (MSM) have been substantially affected by HIV epidemics worldwide. Epidemics in MSM are re-emerging in many high-income countries and gaining greater recognition in many low income and middle-income countries. Better HIV prevention strategies are urgently needed. Our review of HIV prevention strategies for MSM identified several important themes. At the beginning of the epidemic, stand-alone behavioral interventions mostly aimed to reduce unprotected anal intercourse, which, although somewhat efficacious, did not reduce HIV transmission. Biomedical prevention strategies reduce the incidence of HIV infection. Delivery of barrier and biomedical interventions with coordinated behavioral and structural strategies could optimize the effectiveness of prevention. Modeling suggests that, with sufficient coverage, available interventions are sufficient to avert at least a quarter of new HIV infections in MSM in diverse countries. Scale-up of HIV prevention programs for MSM is difficult because of homophobia and bias, suboptimum access to HIV testing and care, and financial constraints.

Tieu, H. V., Spikes, P., Patterson, J., Bonner, S., Egan, J. E., Goodman, K., Koblin, B. A. (2012). Sociodemographic and risk behavior characteristics associated with unprotected sex with women among black men who have sex with men and women in New York City. AIDS Care, 24(9), 1111-1119. doi: 10.1080/09540121.2012.672723

The objectives of this cross-sectional study were to compare sociodemographic and risk behavior characteristics between black men who have sex with both men and women (MSMW) and those who have sex with men only (MSMO) and assess factors associated with having any unprotected vaginal and/or anal intercourse (UVAI) with women in the last 3 months. Data from 326 black men who reported recent unprotected anal intercourse with a man in an HIV behavioral intervention study in New York City were analyzed. Baseline characteristics were compared between MSMW and MSMO, and factors associated with having any UVAI in the past 3 months with women among MSMW were evaluated. In total, 26.8% reported having sex with both men and women in the last 3 months. MSMW were less likely to be HIV infected, use amyl nitrates, and have unprotected receptive anal sex with most recent male partner. MSMW were more likely to be over 40 years old and use heroin. A total of 55.6% of MSMW reported having UVAI with women in the last 3 months. Compared to MSMW having only protected sex, MSMW having any UVAI with women were less likely to be HIV infected and to disclose having sex with men to female partners; they were more likely to have greater than four male sex partners in the last 3 months. In conclusion, HIV prevention interventions among black MSMW should directly address the risk of HIV transmission to both their female and male partners. Disclosure of bisexuality to female partners may be an important component of future prevention efforts.

Wei, C., Guadamuz, T. E., Lim, S. H., Huang, Y., & Koe, S. (2012). Patterns and levels of illicit drug use among men who have sex with men in Asia. Drug Alcohol Depend, 120(1-3), 246-249. doi: 10.1016/j.drugalcdep.2011.07.016

The emergence of gay communities in Asia may predispose men who have sex with men (MSM) to drug use. We describe patterns and levels of illicit drug use, and characteristics of stimulant drug users among MSM in Asia. METHODS: A cross-sectional Internet-based survey was conducted among 10,861 participants recruited through online methods. Pearson’s chi-square tests were used to compare patterns of drug use by participants’ HIV status. Multivariable logistic regression analysis was conducted to identify significant correlates of stimulant drug use. RESULTS: Overall, 16.7% of participants reported recreational drug use in the past 6 months. Ecstasy (8.1%) and Viagra (7.9%) were the most prevalent drugs being used. HIV-positive MSM reported significantly higher levels of individual drug use and polydrug use compared to HIV-negative/unknown MSM. Being gay (AOR=1.62, 95% CI: 1.28, 2.05), having casual male partners only or having both casual and regular partners (AOR=2.05, 95% CI: 1.66, 2.53; AOR=2.97, 95% CI: 2.39, 3.69), HIV-positive status (AOR=4.54, 95% CI: 3.63, 5.69), sex work (AOR=1.52, 95% CI: 1.19, 1.93), and having more gay friends (“Some” vs. “A few/None” AOR=1.98, 95% CI: 1.62, 2.43; “Most/All” vs. “A few/None” AOR=4.59, 95% CI: 3.77, 5.59) were independently associated with stimulant drug use. CONCLUSIONS: Our findings point to the urgency of incorporating substance use prevention and treatment into current HIV prevention activities in Asia, which must use a harm reduction approach and galvanize dignity.

Wei, C., Guadamuz, T. E., Lim, S. H., & Koe, S. (2012). Sexual transmission behaviors and serodiscordant partnerships among HIV-positive men who have sex with men in Asia. Sex Transm Dis, 39(4), 312-315. doi: 10.1097/OLQ.0b013e31824018e8

We described sexual transmission behaviors and serodiscordant partnerships among an online sample of HIV positive men who have sex with men (N = 416) in Asia. High rates of unprotected anal intercourse (74.8%), serodiscordant partnerships (68.5%), and unprotected sex within serodiscordant partnerships (approximately 60.0%) were reported. Increased number of partners, meeting partners on the Internet, drug use before sex, and not knowing one’s viral load were associated with unprotected anal intercourse. Efforts to develop and scale up biomedical and behavioral interventions for HIV-positive men who have sex with men in Asia are needed.

Wei, C., Lim, S. H., Guadamuz, T. E., & Koe, S. (2012). HIV disclosure and sexual transmission behaviors among an Internet sample of HIV-positive men who have sex with men in Asia: implications for prevention with positives. AIDS Behav, 16(7), 1970-1978. doi: 10.1007/s10461-011-0105-x

The relationship between HIV disclosure and sexual transmission behaviors, and factors that influence disclosure are unknown among HIV-positive men who have sex with men (MSM) in Asia. We describe disclosure practices and sexual transmission behaviors, and correlates of disclosure among this group of MSM in Asia. A cross-sectional multi-country online survey was conducted among 416 HIV-positive. Data on disclosure status, HIV-related risk behaviors, disease status, and other characteristics were collected. Multivariable logistic regression was used to identify significant correlates of disclosure. Only 7.0% reported having disclosed their HIV status to all partners while 67.3% did not disclose to any. The majority (86.5%) of non-disclosing participants had multiple partners and unprotected insertive or receptive anal intercourse with their partners (67.5%). Non-disclosure was significantly associated with non-disclosure from partners (AOR = 37.13, 95% CI: 17.22, 80.07), having casual partners only (AOR = 1.91, 95% CI: 1.03, 3.53), drug use before sex on a weekly basis (AOR: 6.48, 95% CI: 0.99, 42.50), being diagnosed with HIV between 1 and 5 years ago (AOR = 2.23, 95% CI: 1.05, 4.74), and not knowing one’s viral load (AOR = 2.80, 95% CI: 1.00, 7.83). Given the high HIV prevalence and incidence among MSM in Asia, it is imperative to include Prevention with Positives for MSM. Interventions on disclosure should not solely focus on HIV-positive men but also need to include their sexual partners and HIV-negative men.

Wei, C., McFarland, W., Colfax, G. N., Fuqua, V., & Raymond, H. F. (2012). Reaching black men who have sex with men: a comparison between respondent-driven sampling and time-location sampling. Sex Transm Infect, 88(8), 622-626. doi: 10.1136/sextrans-2012-050619

The authors explored whether respondent-driven sampling (RDS) can generate a more diverse sample of black men who have sex with men (MSM) than time-location sampling (TLS) by comparing sample characteristics accrued by each method in two independent studies. METHODS: The first study exclusively recruited black MSM through RDS (N=256), while the second recruited MSM through TLS including a subsample of black MSM (N=69). Crude and adjusted point estimates and 95% CIs were calculated for socio-demographic and behavioral characteristics, HIV prevalence and prevalence of unrecognized infections, and were compared using the Z-test. RESULTS: The samples differed significantly regarding all socio-demographic and some behavioural characteristics. Compared with TLS, RDS estimated higher proportions of older, less educated, poorer, currently homeless and self-identified bisexual black MSM. Participants in RDS were less likely to have a main partner, had fewer male partners, were more likely to have a female partner and have both male and female partners, and reported greater methamphetamine, crack and heroin use. Prevalence of HIV and unrecognized infections were slightly higher among RDS participants. CONCLUSIONS: The RDS sample comprised black MSM who were more diverse with respect to socio-demographic characteristics and may also be at higher risk for HIV. Thus, RDS has advantages in reaching higher risk black MSM who are most hidden from intervention research and service delivery. Future studies of black MSM using RDS could use steering strategies to recruit younger participants and other subgroups of greatest interest to public health and prevention.

Yan, H., Yang, H., Zhao, J., Wei, C., Li, J., Huan, X., McFarland, W. (2012). Long-chain peer referral of men who have sex with men: a novel approach to establish and maintain a cohort to measure HIV incidence, Nanjing, China. J Acquir Immune Defic Syndr, 59(2), 177-184. doi: 10.1097/ QAI.0b013e318239c947

HIV prevalence is high among men who have sex with men (MSM) in China. Longitudinal studies are needed to measure HIV incidence, determine causes of acquisition, and test prevention interventions. We described 2 novel methods to enroll and maintain a cohort of MSM, focusing on their abilities to establish a diverse sample, improve retention, and their impact on HIV incidence. METHODS: Employing methods based on respondent-driving sampling, we constructed 2 parallel cohorts measuring HIV incidence over 2 years through 6-month follow-up visits. An initial cohort was constructed using long-chain peer referral from the community; a second phase comprised open cohort peer referral recruitment from MSM completing follow-up. RESULTS: Three-hundred ninety-seven HIV-negative MSM were enrolled in the initial cohort; 460 were recruited in the open cohort phase. Across recruitment waves, the composition of the cohort was stable. Among initial participants, retention was 72.0%, 68.8%, 49.9%, and 44.8%. Retention was lower in the open cohort. MSM retained in both phases were less risky than those lost to follow-up. HIV incidence was 3.36 per 100 person-years and did not differ by recruitment method. CONCLUSIONS: Our approach efficiently recruited MSM into longitudinal studies with modest improvement in sample diversity from initial recruits. We perceive multiple means to improve diversity and follow-up capitalizing on the network bonds between recruits and through secondary incentives for assistance with referral and retention. Meanwhile, HIV incidence is high among MSM in Nanjing, and interventions need to be developed and tested in longitudinal randomized controlled trials.

 

2011

Carrico, A. W., Pollack, L. M., Stall, R. D., Shade, S. B., Neilands, T. B., Rice, T. M., et al. (2011). Psychological processes and stimulant use among men who have sex with men.  Drug and Alcohol Dependence  (available online Nov 15, 2011, http://dx.doi.org/10.1016/j.drugalcdep.2011.10.020)

BACKGROUND: Prior research established that psychological factors are associated with the frequency of stimulant (i.e., cocaine, crack, and methamphetamine) use among substance-using men who have sex with men (MSM). The present investigation examined whether and how psychological factors are associated with engagement in any stimulant use in the broader population of MSM. METHODS: A probability sample of 879 MSM residing in San Francisco was obtained using random digit dialing from May of 2002 through January of 2003. Of these, 711 participants (81%) completed a mail-in questionnaire that assessed psychological factors and substance use. After accounting for demographic factors, a multiple logistic regression analysis examined correlates of any self-reported stimulant use during the past 6 months. Path analyses examined if the use of alcohol or other substances to avoid negative mood states (i.e., substance use coping) mediated the associations of sexual compulsivity and depressed mood with stimulant use. RESULTS: Younger age (adjusted OR [AOR]=0.58; 95% CI=0.47-0.70), HIV-positive serostatus (AOR=2.55; 95% CI=1.61-4.04), greater depressed mood (AOR=1.26; 95% CI=1.05-1.52) and higher sexual compulsivity (AOR=1.46; 95% CI=1.18-1.80) were independently associated with increased odds of stimulant use. Substance use coping partially mediated the associations of sexual compulsivity (beta(indirect)=0.11, p<.001) and depressed mood (beta(indirect)=0.13, p<.001) with stimulant use. CONCLUSIONS: Clinical research is needed to examine if interventions targeting sexual compulsivity and emotion regulation reduce stimulant use among MSM.

Egan, J. E., Frye, V., Kurtz, S. P., Latkin, C., Chen, M., Tobin, K., et al. (2011). Migration, neighborhoods, and networks: Approaches to understanding how urban environmental conditions affect syndemic adverse health outcomes among gay, bisexual and other men who have sex with men. AIDS and Behavior, 15 Suppl 1, S35-50.

Adopting socioecological, intersectionality, and lifecourse theoretical frameworks may enhance our understanding of the production of syndemic adverse health outcomes among gay, bisexual and other men who have sex with men (MSM). From this perspective, we present preliminary data from three related studies that suggest ways in which social contexts may influence the health of MSM. The first study, using cross-sectional data, looked at migration of MSM to the gay resort area of South Florida, and found that amount of time lived in the area was associated with risk behaviors and HIV infection. The second study, using qualitative interviews, observed complex interactions between neighborhood-level social environments and individual-level racial and sexual identity among MSM inNew York City. The third study, using egocentric network analysis with a sample of African American MSM inBaltimore, found that sexual partners were more likely to be found through face-to-face means than the Internet. They also observed that those who co-resided with a sex partner had larger networks of people to depend on for social and financial support, but had the same size sexual networks as those who did not live with a partner. Overall, these findings suggest the need for further investigation into the role of macro-level social forces on the emotional, behavioral, and physical health of urban MSM. PMID: 21369730

Friedman, M. S., Marshal, M. P., Guadamuz, T. E., Wei, C., Wong, C. F., Saewyc, E., et al. (2011). A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. American Journal of Public Health, 101(8), 1481-1494.

OBJECTIVES: We compared the likelihood of childhood sexual abuse (under age 18), parental physical abuse, and peer victimization based on sexual orientation. METHODS: We conducted a meta-analysis of adolescent school-based studies that compared the likelihood of childhood abuse among sexual minorities vs sexual nonminorities. RESULTS: Sexual minority individuals were on average 3.8, 1.2, 1.7, and 2.4 times more likely to experience sexual abuse, parental physical abuse, or assault at school or to miss school through fear, respectively. Moderation analysis showed that disparities between sexual minority and sexual nonminority individuals were larger for (1) males than females for sexual abuse, (2) females than males for assault at school, and (3) bisexual than gay and lesbian for both parental physical abuse and missing school through fear. Disparities did not change between the 1990s and the 2000s. CONCLUSIONS: The higher rates of abuse experienced by sexual minority youths may be one of the driving mechanisms underlying higher rates of mental health problems, substance use, risky sexual behavior, and HIV reported by sexual minority adults. PMID: 21680921

Guadamuz, T. E., Lim, S. H., Marshal, M. P., Friedman, M. S., Stall, R. D., & Silvestre, A. J. (2011). Sexual, behavioral, and quality of life characteristics of healthy weight, overweight, and obese gay and bisexual men: Findings from a prospective cohort study. Archives of Sexual Behavior, 2011 Oct 25.

While there have been attempts to explore the association of obesity and risky sexual behaviors among gay men, findings have been conflicting. Using a prospective cohort of gay and bisexual men residing in Pittsburgh, we performed a semi-parametric, group-based analysis to identify distinct groups of trajectories in body mass index slopes over time from 1999 to 2007 and then correlated these trajectories with a number of psychosocial and behavioral factors, including sexual behaviors. We found many men were either overweight (41.2%) or obese (10.9%) in 1999 and remained stable at these levels over time, in contrast to recent increasing trends in the general population. Correlates of obesity in our study replicated findings from the general population. However, we found no significant association between obesity and sexual risk-taking behaviors, as suggested from several cross-sectional studies of gay men. While there was not a significant association between obesity and sexual risk-taking behaviors, we found high prevalence of overweight and obesity in this population. Gay and bisexual men’s health researchers and practitioners need to look beyond HIV and STI prevention and also address a broader range of health concerns important to this population. PMID: 22038410

Guadamuz, T. E., Wimonsate, W., Varangrat, A., Phanuphak, P., Jommaroeng, R., McNicholl, J. M., et al. (2011). HIV prevalence, risk behavior, hormone use and surgical history among transgender persons in Thailand. AIDS and Behavior, 15(3), 650-658.

While Male-to-female transgender persons (TG) are believed to often engage in sex work and have high HIV infection risk, little is known about demographics, surgical and hormone use history, risk behaviors and HIV prevalence. Between March and October 2005, 474 TG from Bangkok, Chiangmai, and Phuket were surveyed using venue-day-time sampling. Of 474 participants, overall HIV prevalence was 13.5%. Most participants had completed at least secondary or vocational education (79.2%), gender self-identified as female (89.0%), had received money, gifts or valuables for sex (60.8%), and reported hormone use (88.6%). Surgical history was taken from 325 participants. Of these, 68.6% reported some form of surgery and 11.1% had undergone penile-vaginal reconstructive surgery. In multivariate analysis, being recruited from a park/street; older age, anal sex role identification as “versatile” and anal sex debut before age 13 were independently associated with HIV prevalence. The development, implementation and evaluation of culturally appropriate sexual health interventions for Thai TG is urgently needed. PMID: 21104008

Guadamuz, T. E., Wimonsate, W., Varangrat, A., Phanuphak, P., Jommaroeng, R., Mock, P. A., et al. (2011). Correlates of forced sex among populations of men who have sex with men in Thailand. Archives of Sexual Behavior, 40(2), 259-266.

Although forced sex is a correlate of HIV infection, its prevalence and associated risks are not well described among men who have sex with men (MSM) in developing-country settings. Between March and October 2005, we assessed the prevalence of forced sex and correlates among populations of MSM (this includes general MSM, male sex workers, and male-to-female transgender persons) in Thailand using a community-based sample. Participants were enrolled from venues around Bangkok, Chiangmai, and Phuket using venue day-time sampling. Handheld computer-assisted self-interviewing was used to collect demographic and behavioral data and logistic regression evaluated factors associated with forced sex, defined as ever being forced to have sexual intercourse against one’s will. Of the 2,049 participants (M age, 24.8 years), a history of forced sex was reported by 376 (18.4%) men and, of these, most were forced by someone they knew (83.8%), forced more than once (67.3%), and had first occurrence during adolescence (55.1%). In multivariate analysis, having a history of forced sex was significantly associated with being recruited in Phuket, classification as general MSM or transgender (versus classification as male sex worker), drug use, increased number of male sexual partners, and buying sex. The findings in our assessment were consistent with assessments from Western countries. Longitudinal studies are needed to understand the mechanisms of the relationships between forced sex correlates found in our assessment and HIV acquisition and transmission risks. PMID: 19830540

Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D., D’Augelli, A. R., et al. (2011). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. Journal of Homosexuality, 58(1), 10-51.

Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice. PMID: 21213174

Hawk, M., & Davis, D. (2011). The effects of a harm reduction housing program on the viral loads of homeless individuals living with HIV/AIDS. AIDS Care. doi: 10.1080/09540121.2011.630352

Although the advent of highly active antiretroviral therapies has increased survival rates for many individuals living with HIV/AIDS, chronically homeless individuals with the disease continue to experience poor clinical outcomes and high mortality rates in comparison to the general population living with HIV. Housing as a structural intervention for homeless people living with HIV/AIDS has been shown both to be feasible and to improve access to care. However, few studies report the impact of accessing stable housing on residents’ viral load counts, even though viral load has been accepted as the best predictor of clinical prognosis for over a decade. The Open Door is a nonprofit agency that utilizes a harm reduction, housing first model of care to improve clinical outcomes for homeless people living with HIV. This article describes the first study that utilizes viral load to assess the effectiveness of a housing first approach. During the study period, we found that 69% of residents of The Open Door achieved undetectable viral loads, which far exceeds adherence rates ranging from 13 to 32% that were found in other studies of similar vulnerable populations. This finding supports the feasibility of this approach and its potential impact on reducing HIV morbidity, mortality, and secondary transmission. Given that the majority of the residents were active substance users during the study period and achieved undetectable viral loads, our findings also substantiate other studies demonstrating that substance users are able to maintain clinical adherence.

Hecht, J., Riggs, J., Hargraves, H., Wei, C., & Raymond, H. F. (2011). “Are you iffy?”: A social marketing campaign to address uncertainty in HIV status communication among men who have sex with men. Sexually Transmitted Diseases, 38(5), 457-458. PMID: 22256338

Herrick, A. L., Lim, S. H., Wei, C., Smith, H., Guadamuz, T., Friedman, M. S., et al. (2011). Resilience as an untapped resource in behavioral intervention design for gay men. AIDS and Behavior, 15 Suppl 1, S25-9.

Men who have sex with men experience high rates of psychosocial health problems such as depression, substance use, and victimization that may be in part the result of adverse life experiences related to cultural marginalization and homophobia. These psychosocial health conditions interact to form a syndemic which may be driving HIV risk within this population. However, MSM also evidence great resilience to both the effects of adversity and the effects of syndemics. Investigating and harnessing these natural strengths and resiliencies may enhance HIV prevention and intervention programs thereby providing the additional effectiveness needed to reverse the trends in HIV infection among MSM. PMID: 21344306

Herrick, A. L., Marshal, M. P., Smith, H. A., Sucato, G., & Stall, R. D. (2011). Sex while intoxicated: A meta-analysis comparing heterosexual and sexual minority youth. The Journal of Adolescent Health : Official publication of the Society for Adolescent Medicine, 48(3), 306-309.

BACKGROUND: The social marginalization and victimization experienced by sexual minority youth (SMY) may lead to increased risk behaviors and higher rates of negative health outcomes compared with their heterosexual peers. METHODS: We conducted a meta-analysis to examine whether SMY reported higher rates of sex while intoxicated. Studies that report rates of substance use during sex in both SMY and heterosexual youth and had a mean participant age of 18 or less were included in our meta-analysis. Effect sizes were extracted from six studies (nine independent data sets and 24 effect sizes) that met study criteria and had high inter-rater reliability (.98). RESULTS: Results indicated that SMY were almost twice as likely to report sex while intoxicated as compared with heterosexual peers. A random-effects meta-analysis showed a moderate ([overall weighted effect OR] = 1.91, p < .0001) weighted effect size for the relationship between sexual orientation and the use of drugs at the time of sexual intercourse, with the mean effect size for each study ranging from 1.21 to 3.50 and individual effect sizes ranging from .35 to 9.86. DISCUSSION: Our findings highlight the need for healthcare providers to screen SMY for participation in substance use during sexual intercourse and to offer risk reduction counseling during office visits. PMID: 21338904

Lim, S. H., & Chan, R. (2011). HIV infection among men who have sex with men in East and South-East Asia- time for action. Sexual Health, 8(1), 5-8. PMID: 21371375

Lim, S. H., Christen, C. L., Marshal, M. P., Stall, R. D., Markovic, N., Kim, K. H., et al. (2011). Middle-aged and older men who have sex with men exhibit multiple trajectories with respect to the number of sexual partners. AIDS and Behavior, (March 10, 2011, Epub ahead of print)

This study aimed to examine trajectories with respect to the number of sexual partners among older men who have sex with men and to determine characteristics associated with trajectory groups. Nagin’s group-based modeling was used to identify trajectories for 237 men from the Pitt Men’s Study with respect to the number of male intercourse partners from age 50.0 to 59.5. Three distinct trajectory groups were identified. Most men (69.2%) had a median of two sexual partners in the past 6 months across the age range of the study. A smaller group (19.4%) had low or no sex partners. The smallest group (11.4%) had 30 or more sexual partners in the past 6 months at age 50. The groups were statistically different with respect to race, HIV status, drug use (marijuana, poppers, crack cocaine, and Viagra), the number of unprotected anal sex partners, and personal attitudes towards sex.

Marshal, M. P., Dietz, L. J., Friedman, M. S., Stall, R., Smith, H. A., McGinley, J., et al. (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: A meta-analytic review. The Journal of Adolescent Health : Official publication of the Society for Adolescent Medicine, 49(2), 115-123.

PURPOSE: To examine disparities between sexual minority youth (SMY) and heterosexual youth in rates of suicidality and depression symptoms. METHODS: Separate meta-analyses were conducted to examine suicidality and depression disparities. Studies were included if the average age of the participants was <18 years, and if suicidality or depression symptoms were compared across SMY and heterosexual youth. RESULTS: SMY reported significantly higher rates of suicidality (odds ratio [OR] = 2.92) and depression symptoms (standardized mean difference, d = .33) as compared with the heterosexual youth. Disparities increased with the increase in the severity of suicidality (ideation [OR = 1.96], intent/plans [OR = 2.20], suicide attempts [OR = 3.18], suicide attempts requiring medical attention [OR = 4.17]). Effects did not vary across gender, recruitment source, and sexual orientation definition. CONCLUSIONS: Disparities in suicidality and depression may be influenced by negative experiences including discrimination and victimization. Clinicians should assess sexual orientation, analyze psychosocial histories to identify associated risk factors, and promote prevention and intervention opportunities for SMY and their families. PMID: 21783042

McFarland, W., Chen, Y. H., Raymond, H. F., Nguyen, B., Colfax, G., Mehrtens, J., et al. (2011). HIV seroadaptation among individuals, within sexual dyads, and by sexual episodes, men who have sex with men, San Francisco, 2008. AIDS Care, 23(3), 261-268.

“Seroadaptation” comprises sexual behaviors to reduce the risk of HIV acquisition and transmission based on knowing one’s own and one’s sexual partners’ serostatus. We measured the prevalence of seroadaptive behaviors among men who have sex with men (MSM) recruited through time-location sampling (TLS) across three perspectives: by individuals (N = 1207 MSM), among sexual dyads (N = 3746 partnerships), and for sexual episodes (N = 63,789 episodes) in the preceding six months. Seroadaptation was more common than 100% condom use when considering the consistent behavioral pattern of individuals (adopted by 39.1% vs. 25.0% of men, respectively). Among sexual dyads 100% condom use was more common than seroadaptation (33.1% vs. 26.4%, respectively). Considering episodes of sex, not having anal intercourse (65.0%) and condom use (16.0%) were the most common risk reduction behaviors. Sex of highest acquisition and transmission risks (unprotected anal intercourse with a HIV serodiscordant or unknown status partner in the riskier position) occurred in only 1.6% of sexual episodes. In aggregate, MSM achieve a high level of sexual harm reduction through multiple strategies. Detailed measures of seroadaptive behaviors are needed to effectively target HIV risk and gauge the potential of serosorting and related sexual harm reduction strategies on the HIV epidemic. PMID: 21347888

McGowan, I.(2011). Rectal microbicides: Can we make them and will people use them? AIDS and Behavior, 15 Suppl 1, S66-71.

The results of the CAPRISA 004 and iPrEx HIV prevention studies have demonstrated that topical or systemic use of antiretroviral agents can significantly reduce the risk of HIV acquisition associated with unprotected vaginal or anal sexual intercourse. However, the effect size in these studies was relatively modest and product adherence was generally poor. These observations suggest the need for new approaches to HIV prevention, especially for high risk MSM. Rates of lubricant use are high in MSM practicing receptive anal sex. Consequently, the development of an antiretroviral rectal microbicide gel may provide a safe and effective means of preventing HIV infection with an intervention that is likely to have high acceptability among the target population. The purpose of this article is to describe the challenges and progress in the development of rectal microbicides for HIV prevention. PMID: 21331798

Ragin, C., Edwards, R., Larkins-Pettigrew, M., Taioli, E., Eckstein, S., Thurman, N., Boome, J. and Markovic, N.  (2011). Oral HPV infection and sexuality: A cross-sectional study in women. International Journal of Molecular Sciences, 12(6), 3928-3940.

Human Papillomavirus (HPV) is the main risk factor for cervical cancers and is associated with close to 36% of oropharyngeal cancers. There is increasing evidence that oral HPV transmission is related to sexual behavior but to our knowledge studies that involve women who have sex with women have not been performed. We examined the prevalence of oral HPV according to sexual behavior among a population-based sample of 118 women and have made some inferences of possible predictors of oral HPV infection. Women were categorized as heterosexual (history of vaginal sex and/or oral sex with males only, n = 75), bisexual (history of vaginal sex and oral sex with females, n = 32) and other (no history of vaginal sex but oral sex with females [homosexuals], virgins and women with incomplete sexual exposure data, n = 11) The prevalence of oral HPV infection was 12/118 (10.2%) for the overall study population and was not significantly different between heterosexual and bisexual women (10.7% (8/75) vs. 12.5% (4/32), p = 0.784). There was no oral HPV detected among homosexual women, virgins or among women where sexual exposure was unknown. Never smokers were more likely to be oral HPV+ compared to former smokers (Adjusted Odds Ratio (Adj OR) = 0.1, 95% CI, 0.0-1.1) and there was no difference in risk between never smokers and current smokers (Adj OR = 0.7, 95% CI, 0.1-4.6). Twenty-five percent (3/12) of oral HPV+ women had a history of HPV and/or genital warts compared to 9% (10/106) of oral HPV-women (p = 0.104). For the women with a history of vaginal sex (n = 110), oral HPV status was statistically significantly different according to oral sex exposure (p = 0.039). A higher proportion of oral HPV-positive women reported that they had no history of oral sex exposure compared to oral HPV-negative women (4/12, 33% vs. 7/98, 8%). The prevalence of cervical HPV infection did not vary between heterosexuals and bisexuals (35.7% (25/70) vs. 35.5% (11/31), p-value 0.411) and for all other women the cervical HPV prevalence was significantly lower (11.1%, 1/9). Our study suggests that smoking and sexual behavior involving males rather than female partners may be possible predictors of oral HPV infection in women. Further studies with larger sample size are needed to confirm these findings. PMID: 21747715

Raymond, H. F., Chen, Y. H., Stall, R. D., & McFarland, W. (2011). Adolescent experiences of discrimination, harassment, connectedness to community and comfort with sexual orientation reported by adult men who have sex with men as a predictor of adult HIV status. AIDS and Behavior, 15(3), 550-556.

Using data from a probability based sample of adult men who have sex with men (MSM) we examined the association of negative life factors during adolescence and adult HIV status. 521 MSM reported on experiences of connectedness to community, comfort with sexuality, harassment and discrimination due to their sexual orientation at ages 12-18 years. HIV status was determined by serological testing. Overall, men reported moderate levels of being harassed, being discriminated against and high levels of feeling disconnected from gay communities while reporting high levels of being uncomfortable with their sexuality at those ages. However, in analyses of scores on these factors, higher experiences of harassment, higher levels of discrimination and more discomfort with sexuality at these ages are associated with HIV-negative status as adults. This study suggests that the relationship between negative adolescent experiences among MSM and adult HIV infection may not be straightforward, but may also dependent upon aspects of the intensity of the negative experiences, the relationship of the victim and the perpertrator(s), the sexual identity of the victim at the time and/or the number of these experiences or the length of time over which they occurred. Studies investigating specific multiple stressors in adolescent gay development and their effect on adult health outcomes are needed. PMID: 19915973

Raymond, H. F., Hughes, A., O’Keefe, K., Stall, R. D., & McFarland, W. (2011). Hepatitis C prevalence among HIV-positive MSM in San Francisco: 2004 and 2008. Sexually Transmitted Diseases, 38(3), 219-220.

Recent reports suggest the potential for an epidemic of Hepatitis C among nonintravenous drug-using HIV-positive men who have sex with men. HIV-positive specimens from surveillance surveys in 2004 and 2008 were tested for HCV antibodies. Among noninjection drug using men who have sex with men, HCV prevalence was 8.7% and 4.5% in 2004 and 2008, respectively. There was no evidence of a change in HCV prevalence between 2004 and 2008. PMID: 20938373

Smith, H. A., Markovic, N., Matthews, A. K., Danielson, M. E., Kalro, B. N., Youk, A. O., et al. (2011). A comparison of polycystic ovary syndrome and related factors between lesbian and heterosexual women. Women’s Health Issues : Official publication of the Jacobs Institute of Women’s Health, 21(3), 191-198.

OBJECTIVES: Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder associated with infertility, cardiovascular disease and type 2 diabetes. Despite anecdotal evidence that lesbians may have higher PCOS rates than heterosexuals, little empirically based evidence supports this theory. To address this gap, we examined PCOS prevalence and associated factors among a community sample of lesbian and heterosexual women. METHODS: Lesbian (n = 114) and heterosexual (n = 97) women aged 35 to 45 who participated in The Epidemiologic Study of Health Risk (ESTHER) Project (Pittsburgh, PA) were recruited into our PCOS exploratory study between April and October 2008. A reproductive endocrinologist, “blinded” to participant sexual orientation, identified women with PCOS using a modified version of the 2003 Rotterdam Diagnostic Criteria for PCOS. Sexual orientation was defined by self-reported sexual identity, behavior, and attraction. Fisher’s exact, chi-square, and Wilcoxon rank-sum tests were used for analysis. RESULTS: Approximately 6.2% (n = 13) of the total sample (n = 211) had PCOS. PCOS rates did not significantly differ between lesbian and heterosexual women ([7.9%, n = 9] vs. [4.1%, n = 4]; p = .256). No significant differences in PCOS-related factors were found between lesbian and heterosexual women: polycystic ovaries ([10.5%, n = 12] vs. [6.2%, n = 6]; p = 0.261), hirsutism ([24.6%, n = 28] vs. [15.5%, n = 15]; p = 0.102), oligomenorrhea ([3.6%, n = 4] vs. [5.4%, n = 5]; p = 0.735), adult acne ([21.1%, n = 24] vs. [24.7%, n = 24], p = 0.524), and median testosterone ([1.69 ng/mL, n = 114] vs. [1.52 ng/mL, n = 97]; p = 0.069) and rostenedione ([1.63 ng/mL, n = 114] vs. [1.51 ng/mL, n = 97]; p = 0.079) concentrations, respectively. CONCLUSION: PCOS and related factors did not differ by sexual orientation. Despite this, our observed rates warrant the need for additional studies to examine the relationship between PCOS diagnoses, PCOS-related factors, and sexual orientation. PMID: 21310628

Stall, R., Wei, C., Raymond, H. F., & McFarland, W. (2011). Do rates of unprotected anal intercourse among HIV-positive MSM present a risk for Hepatitis C transmission? Sexually Transmitted Infections, 87(5), 439-441.

OBJECTIVES: To compare the rates of unprotected anal intercourse (UAI) among men who have sex with men (MSM) in HIV-seropositive sexual relationships with that among men in HIV-seronegative and serodiscordant relationships in the context of an emerging hepatitis C virus (HCV) epidemic among HIV-positive MSM. METHODS: Time-location sampling was used to obtain a cross-sectional sample of MSM who attended public venues in San Francisco between November 2007 and October 2008 (N = 1199). Behavioural measures of sexual risk-taking at the level of the sexual dyad were administered to the sample. RESULTS: Men in HIV-positive/positive sexual relationships are significantly more likely to have UAI and combine sex and drugs than men in negative/negative sexual relationships. CONCLUSIONS: If it is possible to spread HCV infection between HIV-positive men via UAI, very high levels of behavioural risk among positive MSM should exist to facilitate HCV transmission. Identifying the precise behavioural risk factors for HCV among HIV-positive MSM has become an important public health priority. PMID: 21653934

Tieu, H. V., Xu, G., Bonner, S., Spikes, P., Egan, J. E., Goodman, K., et al. (2011). Sexual partner characteristics, serodiscordant/serostatus unknown unprotected anal intercourse and disclosure among human immunodeficiency virus-infected and uninfected black men who have sex with men in New York City. Sexually Transmitted Diseases, 38(6), 548-554.

OBJECTIVES:  Black men who have sex with men (MSM) are disproportionately infected with human immunodeficiency virus (HIV) in the United States.  This study describes sexual partner characteristics and disclosure of HIV serostatus and evaluates factors associated with sexual risk behaviors during last sex among Black MSM.  DESIGN AND METHODS:  Between 2008 and 2009, 328 Black MSM who reported recent unprotected anal intercourse were enrolled in an HIV behavioral intervention study in New York City. Factors associated with serodiscordant/serostatus unknown UAI (defined as having UAI with a partner of different or unknown HIV serostatus) with a male partner during last sex were assessed using logistic regression. RESULTS: A total of 205 HIV-infected and 123 uninfected men were enrolled in this study. Almost all men (91.6%) reported having a black male partner during last sex. About half (47.3%) of men used alcohol and 38.7% used other substances before or during last sex. About two-thirds (68.8%) of participants disclosed their HIV status to their last sex partner, while 57.2% of partners disclosed. In multivariate analysis, meeting a partner on the internet or chat line was associated with serodiscordant/serostatus unknown UAI during last sex among HIV-infected men. The only factor associated with serodiscordant/serostatus unknown UAI during last sex among HIV-uninfected men was the partner being a non-main partner. CONCLUSIONS: A significant proportion of black MSM in this study did not disclose their HIV status. Our data highlight the need for more data on dyadic variables and sexual risk behaviors among black MSM, as well as interventions to encourage communication between partners. PMID: 21217419

Tsao, J. C., Stein, J. A., Ostrow, D., Stall, R. D., & Plankey, M. W. (2011). The mediating role of pain in substance use and depressive symptoms among multicenter AIDS cohort study (MACS) participants. Pain, 152(12), 2757-2764.

Pain in human immunodeficiency virus (HIV) frequently co-occurs with substance use and depression. The complex associations among patient characteristics, pain, depression, and drug use in HIV suggests a role for testing models that can account for relationships simultaneously, control for HIV status, and also test for mediation. Using structural equation modeling, the current study examined associations among pain, sociodemographics, illicit drug use, and depressive symptoms in 921 HIV-seropositive and 1019 HIV-seronegative men from the Multicenter AIDS Cohort Study, an ongoing prospective study of the natural history of HIV infection among gay/bisexual men. Longitudinal repeated measures data collected over a 6-year period were analyzed using predictive path models in which sociodemographics, HIV status, and CD4+ cell counts predicted pain, which, in turn, predicted depressive symptoms and illicit drug use. The path models did not differ substantially between HIV-seropositive and -seronegative men. Analyses using the total sample indicated that pain served both as a mediator and as a predictor of more use of cannabis, cocaine, and heroin, as well as more depressive symptoms. HIV-seropositive status predicted more use of inhaled nitrites. In this cohort, having lower CD4+ cell counts (predicted by HIV status), being African American, less educated, and older were all associated with more pain, which, in turn, was associated with more illicit drug use and more depressive symptoms. The results underscore the need for adequate pain management, particularly among vulnerable subgroups of HIV-seropositive and HIV-seronegative men to reduce the risk of drug use and depression. PMID: 21962911

Wei C, Guadamuz TE, Lim SH, Koe S. Sexual transmission behaviors and serodiscordant partnerships among HIV-positive men who have sex with men in Asia. Sexually Transmitted Diseases. 2011; [Published online ahead of print Dec 15].

We described sexual transmission behaviors and serodiscordant partnerships among an online sample of HIV-positive MSM (N = 416) in Asia. High rates of UAI (74.8%), serodiscordant partnerships (68.5%), and unprotected sex within serodiscordant partnerships (~60.0%) were reported. Increased number of partners, meeting partners on the Internet, drug use before sex, and not knowing one’s viral load were associated with UAI. Efforts to develop and scale up biomedical and behavioral interventions for HIV-positive MSM in Asia are needed.

Wei, C., Herrick, A., Raymond, H. F., Anglemyer, A., Gerbase, A., & Noar, S. M. (2011). Social marketing interventions to increase HIV/STI testing uptake among men who have sex with men and male-to-female transgender women. Cochrane Database of Systematic Reviews (Online), 9, CD009337.

BACKGROUND: Social marketing interventions have been shown to both promote and change many health-related behaviors and issues. As the HIV epidemic continues to disproportionately affect MSM and transgender women around the world, social marketing interventions have the potential to increase HIV/STI testing uptake among these populations. OBJECTIVES: To assess the impact of social marketing interventions on HIV/STI testing uptake among men who have sex with men and transgender women compared to pre-intervention or control group testing uptake in the same population. SEARCH STRATEGY: We searched the following electronic databases for results from01 January 1980 to the search date, 14 July 2010: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, LILACS (Latin America and Brazil), PsycINFO, PubMed, Web of Science/Web of Social Science, Chinese National Knowledge Infrastructure (CNKI), and CQ VIP (China). We also searched for conference abstracts in the Aegis archive of HIV/AIDS conference abstracts and the CROI and International AIDS Society websites. In addition to searching electronic databases, we searched the following sources of grey literature: Australasian Digital Theses Program, Canadian Evaluation Society, Eastview: China Conference Proceedings, ProQuest Dissertations and Theses, and World Health Organization Library Information System (WHOLIS). We contacted individual researchers, experts working in the field, and authors of major trials for suggestions of any relevant manuscripts that were in preparation or in press. References of published articles from the databases above were searched for additional, pertinent materials. All languages were included in this search. SELECTION CRITERIA: Randomized controlled trials and controlled clinical trials that compared social marketing interventions with a control were included. Interrupted time series and pretest-posttest design studies (controlled or uncontrolled) that compared social marketing interventions with no intervention or a control were also included. Posttest-only studies and studies that combined pre-post data were excluded. Interventions that targeted at general public but did not include MSM or transgender women as a segment or did not have outcome data for an MSM or transgender segment were excluded. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data from each included study and assessed study quality. Meta-analyses were conducted to compare pre- and post-intervention and intervention and control group outcomes of HIV and STI testing uptake. Quality of evidence was assessed using the GRADE approach. MAIN RESULTS: Three serial, cross-sectional pretest-posttest study designs (one with a control group and two without) were included in the final analysis. Statistical pooling was conducted for two studies and compared to pre-intervention level testing uptake, which showed that multi-media social marketing campaigns had a significant impact on HIV testing uptake (OR=1.58, 95%CI = 1.40 – 1.77). However, the campaigns were not found to be effective in increasing STI testing uptake (OR=0.94, 95%CI = 0.68 – 1.28). Overall, risk of bias was high and quality of evidence was low. None of the studies were conducted in developing countries or included male-to-female transgender women. AUTHORS’ CONCLUSIONS: This review provided limited evidence that multi-media social marketing campaigns can promote HIV testing among MSM in developed countries. Future evaluations of social marketing interventions for MSM should employ more rigorous study designs. Long-term impact evaluations (changes in HIV or STI incidence over time) are also needed. Implementation research, including detailed process evaluation, is needed to identify elements of social marketing interventions that are most effective in reaching the target population and changing behaviors. PMID: 21901734

Wei, C., Lim, S. H., Guadamuz, T. E., & Koe, S. (2011). HIV disclosure and sexual transmission behaviors among an internet sample of HIV-positive men who have sex with men in Asia: Implications for prevention with positives. AIDS and Behavior, published online, DOI: 10.1007/s10461-011-0105-x

The relationship between HIV disclosure and sexual transmission behaviors, and factors that influence disclosure are unknown among HIV-positive men who have sex with men (MSM) in Asia. We describe disclosure practices and sexual transmission behaviors, and correlates of disclosure among this group of MSM inAsia. A cross-sectional multi-country online survey was conducted among 416 HIV-positive MSM. Data on disclosure status, HIV-related risk behaviors, disease status, and other characteristics were collected. Multivariable logistic regression was used to identify significant correlates of disclosure. Only 7.0% reported having disclosed their HIV status to all partners while 67.3% did not disclose to any. The majority (86.5%) of non-disclosing participants had multiple partners and unprotected insertive or receptive anal intercourse with their partners (67.5%). Non-disclosure was significantly associated with non-disclosure from partners (AOR = 37.13, 95% CI: 17.22, 80.07), having casual partners only (AOR = 1.91, 95% CI: 1.03, 3.53), drug use before sex on a weekly basis (AOR: 6.48, 95% CI: 0.99, 42.50), being diagnosed with HIV between 1 and 5 years ago (AOR = 2.23, 95% CI: 1.05, 4.74), and not knowing one’s viral load (AOR = 2.80, 95% CI: 1.00, 7.83). Given the high HIV prevalence and incidence among MSM in Asia, it is imperative to include Prevention with Positives for MSM. Interventions on disclosure should not solely focus on HIV-positive men but also need to include their sexual partners and HIV-negative men.

Wei, C., & Raymond, H. F. (2011). Preference for and maintenance of anal sex roles among men who have sex with men: Sociodemographic and behavioral correlates. Archives of Sexual Behavior, 40(4), 829-834.

Self-labeling of, and preference for, anal sex roles is an important aspect of identities and cultures among men who have sex with men (MSM) populations. In this article, we examined sociodemographic and behavioral correlates of preference for and maintenance of anal sex roles, and risk for HIV infection. Using time-location sampling, we conducted a cross-sectional survey of racially diverse MSM in San Francisco. Of the 386 men who reported an anal sex role preference, 41% preferred being “versatile” while 21 and 37% preferred being “bottom” and “top” only. Lower educated men, Asian/Pacific Islander men, and men born in Asia/Philippines were more likely to prefer being “bottom.” Among all racial/ethnic groups, men in general did not maintain their preferences 100% of the time in their reported sexual behavior, and none of the racial/ethnic groups maintained their preference at greater or lesser levels than any other group. There were no significant differences in all the behavioral risks between men who maintained their preferences and those who did not. Yet, prevalence of HIV infection was two times higher among men who were strictly “bottom.” Linguistically and/or culturally appropriate HIV prevention information/interventions at an appropriate educational level should be provided to those from the developing world and those of lower socioeconomic status, who may lack the knowledge of differential risks associated with anal sex activities. PMID: 20464471

Wei, C., Raymond, H. F., Guadamuz, T. E., Stall, R., Colfax, G. N., Snowden, J. M., et al. (2011). Racial/Ethnic differences in seroadaptive and serodisclosure behaviors among men who have sex with men. AIDS and Behavior, 15(1), 22-29.

We examined racial/ethnic differences in reported seroadaptive and serodisclosure behaviors among the partnerships of MSM recruited for a cross-sectional survey using time-location sampling (TLS) in San Francisco during 2007-2008. The sample (N = 1,199) consisted of 12.2% Asian/Pacific Islander (API), 52.4% White, 6.8% Black, 20.2% Latino, and 8.5% of “other” race/ethnicity. Pure serosorting was most common (about 20%) among HIV-negative men while seropositioning was most used (about 15%) by HIV-positive men. Reported seroadaptive behaviors did not differ significantly across races/ethnicities among both HIV-negative and HIV-positive men. However, HIV-positive Black and Latino men were significantly more likely to report no preventive, seroadaptive behavioral strategy (i.e., unprotected insertive anal intercourse with unknown status or serodiscordant partners). Among men who reported engaging in seroadaptive behaviors, they reported not discussing HIV status with a third of their partners-a major concern in that lack of disclosure undermines the effectiveness and means to practice serosorting. Partnerships of API and Black men were least likely to involve serodisclosure behaviors. Our study confirms that seroadaptive behaviors are common preventive strategies reported by MSM of all races/ethnicities, and does not find strong evidence that racial/ethnic differences in seroadaptive behaviors are enhancing disparities in HIV prevalence. The implications are that condom promotion and safe sex messages are not the only prevention measures adopted by MSM and that public health professionals should be well aware of current trends within the MSM community in order to better assist HIV prevention efforts. PMID: 20217468

Wei, C., Raymond, H. F., Wong, F. Y., Silvestre, A. J., Friedman, M. S., Documet, P., et al. (2011). Lower HIV prevalence among Asian/Pacific islander men who have sex with men: A critical review for possible reasons. AIDS and Behavior, 15(3), 535-549.

We conducted a critical literature review for possible reasons that may explain the lower HIV prevalence observed among API MSM compared to MSM of other races/ethnicities. Trends emerging from the literature suggest that traditional individual-level factors-unprotected anal intercourse, substance use, STD prevalence, rates and frequency of HIV testing, and utilization of HIV prevention services-do not appear to be related to the lower HIV prevalence among API MSM. Some evidence suggests that socio-cultural and structural factors might be the more critical forces in determining racial/ethnic disparities of HIV among MSM. For API MSM, these factors include structures of sexual networks, access to and reception of medical care and treatment among HIV-positive MSM, and influences of different levels and types of acculturation. Moreover, emerging risk reduction strategies, such as seroadaptive behaviors, could play a role. Future research should address these factors in intervention design. In addition, better theories of resilience and measurement of strengths and protective factors are needed to enhance the efficacy of HIV interventions. PMID: 21153049

Wei, C., Raymond, H. F., McFarland, W., Buchbinder, S., & Fuchs, J. D. (2011). What is the potential impact of adult circumcision on the HIV epidemic among men who have sex with men in San Francisco? Sexually Transmitted Diseases, 38(4), 353-355.

With the help of a community-based survey, we assess the potential effect of circumcision on the HIV epidemic among men who have sex with men (MSM) in San Francisco. Only a small minority of MSM would both derive benefit from circumcision (i.e., were uncircumcised, HIV-negative, predominantly insertive, and reported unprotected insertive anal sex) and be willing to participate in circumcision trials (0.7%) or be circumcised if proven effective as a prevention strategy (0.9%). Circumcision would have limited public health significance for MSM inSan Francisco.

Wei, C., Ruan, S., Zhao, J., Yang, H., Zhu, Y., & Raymond, H. F. (2011). Which Chinese men who have sex with men miss out on HIV testing? Sexually Transmitted Infections, 87(3), 225-228.

OBJECTIVES: To describe socio-demographic, behavioural and other characteristics associated with HIV testing behaviour among men who have sex with men (MSM) in Jinan, China. METHODS: A cross-sectional survey was conducted among MSM (N=500) in Jinanin 2008 using respondent-driven sampling–a method used worldwide to reach hidden high-risk populations. Bivariate and multivariate analyses, adjusted for the sampling method, were conducted to identify correlates of not having an HIV test. RESULTS: Overall, 80.7% (95% CI 75.0% to 85.0%) of MSM in Jinan have not had an HIV test in the past 12 months. In the multivariate analyses, having not visited the local Centers for Disease Control and Prevention’s website (AOR 5.59, 95% CI 2.62 to 11.95), being over the age of 35 years (AOR 3.77, 95% CI 1.19 to 11.93) and self-identified as bisexual or unsure (AOR 3.85, 95% CI 2.16 to 6.85) are significantly associated with having not had an HIV test. In addition, married men are slightly less likely to have not been tested compared to single men (AOR 0.38, 95% CI 0.17 to 0.85). Those who report meeting their sex partners at high-risk venues are two times more likely to have not had an HIV test (AOR 2.02, 95% CI 0.97 to 4.21). CONCLUSIONS: Targeted, culturally appropriate and innovative interventions to increase HIV testing uptake should be a top priority for HIV prevention among MSM in China. PMID: 21270068

 

2010

Guadamuz, T. E., Kunawararak, P., Beyrer, C., Pumpaisanchai, J., Wei, C., & Celentano, D.D.(2010). HIV prevalence, sexual and behavioral correlates among Shan, Hill tribe, and Thai male sex workers in northern Thailand. AIDS Care, 22(5), 597-605.

This paper reports demographic characteristics, HIV prevalence, and correlates among male sex workers (MSW) in Chiangmai, Thailand. A behavioral assessment survey was included as part of the Thailand Ministry of Public Health HIV sentinel surveillance conducted during June 2003. A sample of 181 MSW from 14 sex establishments around Chiangmai who self-identified as sex workers were interviewed. Non-Thai MSW made up half of the sample (48.6%), with the majority being of Shan ethnicity (64.7%). Thai MSW were significantly more likely to report having had receptive anal intercourse (38.0% vs. 11.8%, p < 0.001) and to have higher HIV prevalence than non-Thai MSW(11.8% vs. 3.4%, p < 0.001). In multivariate analysis, having one or more than one steady male partner in the past month (Odds Ratio: 5.56, 95% Confidence Intervals: 1.13-27.27 and 8.29, 2.01-34.20, respectively), and being older than 21 years (2.26, 1.04-4.90) were significantly and independently associated with prevalent HIV infection. While Thai MSW had higher HIV prevalence and engage in riskier activities, culturally appropriate education and outreach activities are still needed for the large number of ethnic minority MSW, particularly Shan MSW. PMID: 20401764

Herrick, A. L., Matthews, A. K., & Garofalo, R. (2010). Health risk behaviors in an urban sample of young women who have sex with women. Journal of Lesbian Studies, 14(1), 80-92.

We examined the prevalence of sexual and substance use behaviors among a group of young women who have sex with women (WSW) aged 16 to 24. A convenience sample of 137 young WSW participants completed a confidential survey that included demographics, substance use, and sexual risk behaviors. Descriptive analyses were used to interpret the data. Comparisons were made between rates of risk behaviors in this sample and non-sexual minority youth in a national dataset. The mean age of participants was 19.6 (SD = 2.3) and 59% were from communities of color. Participants reported a history of risky behaviors including anal intercourse with men (26%), monthly binge drinking (22%), pregnancy (20%), and tobacco use (54%). These findings highlight the need for health promotion interventions aimed at reducing risky health behaviors in this highly vulnerable and underserved sub-population of young women. PMID: 20077268

Ho, K. S., & Cranston, R. D. (2010). Anal cytology screening in HIV-positive men who have sex with men: What’s new and what’s now? Current Opinion in Infectious Diseases, 23(1), 21-25.

PURPOSE OF REVIEW: This review will discuss current and future anal cytology screening programs to detect anal dysplasia in HIV-positive men who have sex with men (MSM), in addition to other interventions aimed at early detection of anal cancer in this population. RECENT FINDINGS: Evidence of progression from high-grade anal dysplasia to anal cancer has been recently demonstrated and strengthens the clinical imperative to diagnose and treat this lesion in at-risk populations. The use of adjunct molecular techniques that improve specificity of anal cytology screening may have the potential to rationalize current screening referral pathways and focus resources on those at highest risk of progressing to cancer. Candidate biomarkers that are currently being investigated include protein surrogates of cell cycle deregulation (such as p16ink4a and minichromosomal maintenance proteins), DNA damage biomarkers (53BP1) in addition to testing for human papillomavirus genotype, gamma tubulin and beta defensin levels. SUMMARY: Anal cytology, although sensitive for the detection of any anal dysplastic abnormality, has poor specificity to detect high-grade anal dysplasia. As new molecular techniques are evolving, the most important immediate clinical intervention is to educate HIV-positive MSM in order to increase awareness of both risk and clinical symptoms suggestive of progression to anal cancer. In the absence of high-resolution anoscopic expertise, it is recommended that regular digital rectal examinations are performed as most early cancers are palpable even in the absence of clinical symptoms. PMID: 19935419

Pittsburgh Transgender Health Research Summer Institute. Transgender Health: A Review and Guidance for Future Research—Proceedings from the Summer Institute at the Center for Research on Health and Sexual Orientation, University of Pittsburgh. International Journal of Transgenderism 2010;12(4):211-229.

This paper reports on the outcome of the Summer Institute on Transgender Health Research heldJuly 24-26, 2008, at the University of Pittsburgh, Pennsylvania.   The Institute attendees included a panel of experts in the field of transgender research.  The goals of the Institute were to provide an opportunity to learn more about transgender health research, foster a dialogue among experts on transgender health issues, and to come to a consensus on what is needed to move the field forward.  The scope of existing research on the transgender population is limited. While more research is needed on the known health problems of HIV/AIDS, substance use, and mental health, there is also a need to focus on other health issues important to trans/gender-variant people such as cardiovascular health. Participants also identified a need to examine how societal discrimination can create a syndemic process that will affect multiple health disparities.

Ramachandran, S., Yonas, M. A., Silvestre, A. J., & Burke, J. G. (2010). Intimate partner violence among HIV-positive persons in an urban clinic. AIDS Care, 22(12), 1536-1543.

While the intersection of HIV/AIDS and intimate partner violence (IPV) has gained increased attention, little focus has been given to the relationship among minority men and men who have sex with men (MSM). This pilot study, conducted at an urban clinic, explores the IPV experiences of HIV-positive persons involved in both heterosexual and homosexual relationships. Fifty-six HIV-positive individuals were interviewed to assess for verbal, physical, and sexual IPV, and for HIV-related abuse and attitudes regarding routine IPV screening. Approximately three quarters (73%) of the sample reported lifetime IPV and 20% reported current abuse. Physical IPV (85%) was cited the most by abused participants. IPV rates were highest among African-Americans and MSM. More than one-fourth (29%) of those abused felt the abuse was related to their HIV status. A majority of participants favored IPV screening by providers, but felt it might increase risk of IPV. IPV and its association to HIV are significant issues among this sample. Findings support the need for developing new programs that address these epidemics simultaneously. PMID: 20924830

Safren, S. A., Reisner, S. L., Herrick, A., Mimiaga, M. J., & Stall, R. D. (2010). Mental health and HIV risk in men who have sex with men. Journal of Acquired Immune Deficiency Syndromes (1999), 55 Suppl 2, S74-7.

Evidence-based HIV prevention interventions with men who have sex with men (MSM) in the United States have moderate effect sizes in reducing HIV sexual risk behavior. Mental health and psychosocial problems, which both disproportionately affect MSM populations and are implicated in HIV transmission risk behaviors, also likely interfere with the uptake of HIV behavioral interventions. Moreover, given that mental health and psychosocial problems such as depression, substance use, and violence frequently co-occur for many MSM (eg, as syndemic conditions), what is probably needed are combination prevention efforts, or prevention “cocktails,” similar to treatment “cocktails,” that address the psychological and behavioral mechanisms that interact to produce elevated risk for HIV. Such interventions should incorporate a holistic framework to address the sexual health and overall well being of MSM. Addressing co-occurring psychosocial risk factors is apt to improve effect sizes of current HIV prevention interventions and allow for more effective uptake by MSM. PMID: 21406991

Silvestre, A. J., Quinn, S. J., & Rinaldo, C. R. (2010). A twenty-two-year-old community advisory board: Health research as an opportunity for social change. Journal of Community Practice, 18(1), 58-75.

Conducting health research often requires a partnership between marginalized communities and researchers. Community organizers can broker this partnership in a way that not only produces important scientific discoveries but also brings needed resources to the communities. This article is a description of a community advisory board established in 1984 to advise researchers on a longitudinal study of the natural history of AIDS among gay men. The Board successfully guided the recruitment of more than 3,000 gay and bisexual male volunteers and, at the same time worked as a powerful change agent. An analysis of minutes from all Board meetings between 1984-2006 indicates that significant social change as well as important research findings resulted from Board actions. Community organizers who work to create a mutually beneficial partnership between communities and researchers may find new opportunities to support community growth and social justice. PMID: 20523763

Smith, H. A., Markovic, N., Danielson, M. E., Matthews, A., Youk, A., Talbott, E. O., et al. (2010). Sexual abuse, sexual orientation, and obesity in women. Journal of Women’s Health (2002), 19(8), 1525-1532.

BACKGROUND: Among adult women an association between childhood sexual abuse (CSA) and obesity has been observed. Research with lesbian women has consistently identified high rates of obesity as well as frequent reports of CSA, but associations between sexual abuse and obesity have not been fully explored. Our aim was to investigate the relationship between sexual abuse (SA) history and obesity among heterosexual (n = 392) and lesbian (n = 475) women (age 35-64) who participated in the Epidemiologic Study of Health Risk in Women (ESTHER) Project in Pittsburgh, Pennsylvania. METHODS: Obesity was defined as body mass index (BMI) > or =30. Covariates included self-reported SA, sexual orientation, demographic factors, and history of a depression or anxiety diagnosis. SA history was assessed by three factors: (1) SA experienced under the age of 18 by a family member or (2) by a nonfamily member and (3) forced, unwanted sexual experience(s) at age > or =18. Data were analyzed using chi-square tests and logistic regression models. RESULTS: Multiple logistic regression analyses revealed that obesity was associated with African American race, lesbian sexual orientation, intrafamilial CSA, and history of mental health diagnosis. Protective factors were having a household income of at least $75,000 and having a bachelor’s degree or higher. CONCLUSIONS: Results suggest that lesbian women may be at greater risk of obesity than heterosexual women and that intrafamilial CSA–regardless of sexual orientation–may play a role in the development of obesity. PMID: 20524896

Smith, H. A., Matthews, A., Markovic, N., Youk, A., Danielson, M. E., & Talbott, E. O. (2010). A comparative study of complementary and alternative medicine use among heterosexually and lesbian identified women: Data from the ESTHER project (Pittsburgh, PA, 2003-2006). Journal of Alternative and Complementary Medicine (New York, N.Y.), 16(11), 1161-1170.

OBJECTIVES: The prevalence of complementary and alternative medicine (CAM) use among women in theUnited States is high. Little is known about how CAM use may differ based on sexual orientation. Study aims were to measure the prevalence of CAM use in a community sample of women, explore differences in CAM use patterns by sexual orientation, and identify correlates of CAM use. DESIGN/SUBJECTS: Analyses were based on women (Total N = 879; n = 479 lesbians) enrolled in the Epidemiologic STudy of HEalth Risk in Women (ESTHER) Project, a cross-sectional heart-disease risk-factor study. SETTINGS/LOCATION: Data were collected through convenience sampling of adult females in Pittsburgh, PA(2003-2006). OUTCOME MEASURES: Main outcome measures included lifetime and past 12-month CAM use, and types of CAM modalities used in the past 12 months. RESULTS: The prevalence of having ever used CAM was 49.8%, with 42% having reported CAM use within the past 12 months. Lesbians had greater odds of having ever used CAM (adjusted odds ratio [AOR] = 1.68 [95% confidence interval (CI): 1.23, 2.28]) and of having used CAM in the past 12 months (AOR = 1.44 [CI: 1.06, 1.97]) than heterosexuals. In multivariate analyses, correlates of lifetime and past 12-monthCAMuse included being lesbian, white, higher educated, and a large-city resident; experiencing perceived discrimination in a health care setting; and having a greater spirituality rating and a history of a diagnosed mental health disorder. Past 12-month CAM use was also associated with having a provider of usual health care. Among women who used CAM within the past 12 months, heterosexuals had significantly higher yoga participation rates than lesbians. CONCLUSIONS: Sexual orientation is important in understanding lifetime and past 12-month CAM use. Because of the high prevalence of CAM use found in this study, medical practitioners should inquire about the CAM practices of female patients, particularly lesbians. PMID: 21058883

Wang WB, Wei C, Buchholz ME, Martin MC, Smith BD, Huang ZJ, Wong FY. Prevalence and risks for sexually transmitted infections among a national sample of migrants versus non-migrants in China. International Journal of STD and AIDS. 2010; 21: 10-415.

This study aims to describe and compare the gender-specific prevalence of chlamydia and gonorrhea, sexual behaviors and experiences, and risk factors associated with sexually transmitted infections (STIs) among migrants versus rural and urban non-migrants in China. Data were abstracted from the Chinese Health and Family Life Survey conducted from 1999 to 2000, which provided a nationally representative adult (ages 20-64 years) sample. STI results were determined using a urine-based nucleic acid amplification assay. The prevalence of chlamydia for migrant women was triple that of rural non-migrant women. Migrants were more likely to engage in STI-associated risk behaviors than non-migrants (e.g. receiving money for sex). Among migrants, women were more likely than men to have STIs. The high STI prevalence among migrants highlights an urgent need to implement comprehensive prevention and intervention programs targeting the cultural, social and structural needs of migrants in the city, especially migrant women.

 

2009

Carey, J. W., Mejia, R., Bingham, T., Ciesielski, C., Gelaude, D., Herbst, J. H., et al. (2009). Drug use, high-risk sex behaviors, and increased risk for recent HIV infection among men who have sex with men in Chicagoand Los Angeles. AIDS and Behavior, 13(6), 1084-1096.

We examined how drugs, high-risk sexual behaviors, and socio-demographic variables are associated with recent HIV infection among men who have sex with men (MSM) in a case-control study. Interviewers collected risk factor data among 111 cases with recent HIV infection, and 333 HIV-negative controls from Chicago and Los Angeles. Compared with controls, cases had more unprotected anal intercourse (UAI) with both HIV-positive and HIV-negative partners. MSM with lower income or prior sexually transmitted infections (STI) were more likely to be recently HIV infected. Substances associated with UAI included amyl nitrate (“poppers”), methamphetamine, Viagra (or similar PDE-5 inhibitors), ketamine, and gamma hydroxybutyrate (GHB). Cases more frequently used Viagra, poppers, and methamphetamine during UAI compared with controls. In multivariate analysis, income, UAI with HIV-positive partners, Viagra, and poppers remained associated with recent HIV seroconversion. Better methods are needed to prevent HIV among MSM who engage in high-risk sex with concurrent drug use. PMID: 18498049

Chin-Hong, P. V., Husnik, M., Cranston, R. D., Colfax, G., Buchbinder, S., Da Costa, M., et al. (2009). Anal human papillomavirus infection is associated with HIV acquisition in men who have sex with men. AIDS (London, England), 23(9), 1135-1142.

OBJECTIVE: Human papillomavirus (HPV) is a common sexually transmitted agent that causes anogenital cancer and precancer lesions that have an inflammatory infiltrate, may be friable and bleed. Our aim was to determine the association between anal HPV infection and HIV acquisition. DESIGN: A prospective cohort study. METHODS: We recruited 1409 HIV-negative men who have sex with men from a community-based setting in Boston, Denver, New York and San Francisco. We used Cox proportional hazards regression modeling and assessed the independent association of HPV infection with the rate of acquisition of HIV infection. RESULTS: Of 1409 participants contributing 4375 person-years of follow-up, 51 HIV-seroconverted. The median number of HPV types in HPV-infected HIV-seroconverters was 2 (interquartile range 1-3) at the time of HIV seroconversion. After adjustment for sexual activity, substance use, occurrence of other sexually transmitted infections and demographic variables, there was evidence (P = 0.002) for the effect of infection with at least two HPV types (hazard ratio 3.5, 95% confidence interval 1.2-10.6) in HIV seroconversion. CONCLUSION: Anal HPV infection is independently associated with HIV acquisition. Studies that incorporate high-resolution anoscopy to more accurately identify HPV-associated disease are needed to determine the relationship between HPV-associated disease and HIV seroconversion. PMID: 19390418

Friedman, M. S., Marshal, M. P., Stall, R., Kidder, D. P., Henny, K. D., Courtenay-Quirk, C., et al. (2009). Associations between substance use, sexual risk taking and HIV treatment adherence among homeless people living with HIV. AIDS Care, 21(6), 692-700.

Prior research suggests that the interconnections between substance use, HIV risk and lack of adherence to HIV medications are especially strong among homeless individuals. Thus, study of these interconnections warrants public health attention. The objectives of this paper are to describe patterns of alcohol and drug use, associations between substance use and participation in high-risk sex, and associations between substance use and adherence to HIV treatment regimens among a sample of 602 homeless or unstably housed HIV-seropositive individuals who are part of a housing-based intervention–the Housing and Health Study. Participants experienced high levels of substance use. Significant associations were found between substance use and adherence to HIV treatment medications, and between substance use and high-risk sexual practices within the entire group. Group analyses by sexual orientation/gender show that the association between substance use and treatment adherence is found primarily among heterosexual males whereas the relationship between several drugs and high-risk sexual practices is strongest among gay and bisexual men. Health professionals working with HIV-seropositive individuals should routinely ascertain housing status and screen for substance use and risky sex. PMID: 19806485

Lombardi, E. (2009). Varieties of transgender/transsexual lives and their relationship with transphobia. Journal of Homosexuality, 56(8), 977-992.

The conceptualization of gender variant populations within studies have consisted of imposed labels and a diversity of individual identities that preclude any attempt at examining the variations found among gender variant populations, while at the same time creating artificial distinctions between groups that may not actually exist. Data were collected from 90 transgender/transsexual people using confidential, self-administered questionnaires. Factors like age of transition, being out to others, and participant’s race and class were associated with experiences of transphobic life events. Discrimination can have profound impact on transgender/transsexual people’s lives, but different factors can influence one’s experience of transphobia. Further studies are needed to examine how transphobia manifests, and how gender characteristics impact people’s lives. PMID: 19882422

Marshal, M. P., Friedman, M. S., Stall, R., & Thompson, A. L. (2009). Individual trajectories of substance use in lesbian, gay and bisexual youth and heterosexual youth. Addiction (Abingdon, England), 104(6), 974-981.

AIMS: Several decades of research have shown that lesbian, gay and bisexual (LGB) adults are at high risk for substance use and substance use disorders, and a recent meta-analysis shows that these disparities most probably begin in adolescence; however, no studies to date have examined longitudinal growth in substance use in LGB youth and heterosexual youth to determine if they follow different trajectories into young adulthood. The primary aims of this paper were to estimate individual trajectories of substance use in youth and examine differences between self-identified LGB and heterosexual subsamples. METHOD: A school-based, longitudinal study of health-related behaviors of adolescents and their outcomes in young adulthood was used to test our hypotheses (The National Longitudinal Study of Adolescent Health). Participants were included if they were interviewed at all three waves and were not missing information regarding self-identified sexual orientation (n = 10,670). RESULTS: Latent curve models (LCMs) showed that LGB identity was associated significantly with individual variability in substance use intercepts and slopes, above and beyond age, race and gender. Self-identified LGB youth reported higher initial rates of substance use and on average their substance use increased over time more rapidly than did substance use by heterosexual youth. Two other indicators of sexual orientation (same-sex romantic attraction and same-sex sexual behavior) were also associated with substance use trajectories, and differential results were found for youth who identified as ‘mostly heterosexual’ and bisexual compared with youth who identified as completely heterosexual or homosexual. CONCLUSIONS: Sexual orientation is an important risk marker for growth in adolescent substance use, and the disparity between LGB and heterosexual adolescents increases as they transition into young adulthood. More research is needed in order to examine: causal mechanisms, protective factors, important age-related trends (using a cohort-sequential design), the influence of gay-related developmental milestones, curvilinear effects over time and long-term health outcomes. PMID: 19344440

Ostrow, D. G., Plankey, M. W., Cox, C., Li, X., Shoptaw, S., Jacobson, L. P., et al. (2009). Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS. Journal of Acquired Immune Deficiency Syndromes (1999), 51(3), 349-355.

BACKGROUND: New HIV infections are being observed among men who have sex with men (MSM). Understanding the fusion of risky sexual behaviors, stimulant and erectile dysfunction drug use with HIV seroconversion may provide direction for focused intervention. METHODS: During the follow-up period (1998-2008), we identified 57 HIV seroconverters among 1667 initially HIV-seronegative men. Time to seroconversion was modeled using Cox proportional hazards regression analysis for 7 combinations of sex drugs (inhaled nitrites or “poppers”, stimulants, and erectile dysfunction drugs) used at the current or previous semiannual visit, adjusting for other risk factors including sexual behavior, alcohol and other drugs used, and depression. Model-based adjusted attributable risks were then calculated. RESULTS: The risk of seroconversion increased linearly with the number of unprotected receptive anal sex partners (URASP), with hazard ratios ranging from 1.73 [95% confidence interval (CI): 0.75 to 4.01] for 1 partner, to 4.23 (95% CI: 1.76 to 10.17) for 2-4 partners, and to 14.21 (95% CI: 6.27 to 32.20) for 5+ partners, independent of other risk factors. After adjustment, risks for seroconversion increased from 2.99 (95% CI: 1.02 to 8.76) for men who reported using stimulants only (1 drug) to 8.45 (95% CI: 2.67 to 26.71) for men who reported using all 3 sex drugs. The use of any of the 7 possible sex drug combinations accounted for 63% of the 9-year HIV seroincidence in the Multicenter AIDS Cohort Study. When contributions of increased URASP and combination drug use were analyzed together, the total attributable risk for HIV seroconversion was 74%, with 41% attributable to URASP alone and a residual of 33% due to other direct or indirect effects of sex drug use. CONCLUSIONS: Use of poppers, stimulants, and erectile dysfunction drugs increased risk for HIV seroconversion significantly in this cohort. These data reinforce the importance of implementing interventions that target drug reduction as part of comprehensive and efficacious HIV prevention strategies. PMID: 19387357

Stall, R., Duran, L., Wisniewski, S. R., Friedman, M. S., Marshal, M. P., McFarland, W., et al. (2009). Running in place: Implications of HIV incidence estimates among urban men who have sex with men in the united statesand other industrialized countries. AIDS and Behavior, 13(4), 615-629.

Attempts to document changing HIV incidence rates among MSM are compromised by issues of generalizability and statistical power. To address these issues, this paper reports annualized mean HIV incidence rates from the entire published incidence literature on MSM from Europe, North America and Australia for the period 1995-2005. Publications that met the entry criteria were coded for region of the world, sampling method and year of study. From these reports, we calculated a mean incidence rate with confidence intervals for these variables. Although no differences in mean incidence rates were found for MSM from 1995 to 2005, HIV incidence rates are lower in Australia than either North America or Europe. We calculated a mean incidence rate of 2.39% for MSM in the United States, which if sustained within a cohort of MSM, would yield HIV prevalence rate of approximately 40% at age 40. These extrapolations overlap published HIV prevalence rates for MSM younger than age 40 in the United States. HIV incidence rates in the 2-3% range will adversely affect the health of gay male communities for decades to come. This analysis suggests that greater attention should be devoted to the question of how best to design prevention interventions that will lower HIV incidence rates among gay men. PMID: 19205867

Thiede, H., Jenkins, R. A., Carey, J. W., Hutcheson, R., Thomas, K. K., Stall, R. D., et al. (2009). Determinants of recent HIV infection among Seattle-area men who have sex with men. American Journal of Public Health, 99 Suppl 1, S157-64.

OBJECTIVES: We sought to identify HIV-infection risk factors related to partner selection and sexual behaviors with those partners among men who have sex with men (MSM) in King County, Washington. METHODS: Participants were recruited from HIV testing sites in the Seattle area. Recent HIV infection status was determined by the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS) or a self-reported previous HIV-negative test. Data on behaviors with 3 male partners were collected via computer-based self-interviews. Generalized estimating equation models identified partnership factors associated with recent infection. RESULTS: We analyzed data from 32 HIV-positive MSM (58 partners) and 110 HIV-negative MSM (213 partners). In multivariate analysis, recent HIV infection was associated with meeting partners at bathhouses or sex clubs, bars or dance clubs, or online; methamphetamine use during unprotected anal intercourse; and unprotected anal intercourse, except with HIV-negative primary partners. CONCLUSIONS: There is a need to improve efforts to promote condom use with casual partners, regardless of their partner’s HIV status. New strategies to control methamphetamine use in MSM and to reduce risk behaviors related to meeting partners at high-risk venues are needed. PMID: 18445808

Wei, C., Guadamuz, T. E., Stall, R., & Wong, F. Y. (2009). STD prevalence, risky sexual behaviors, and sex with women in a national sample of Chinese men who have sex with men. American Journal of Public Health, 99(11), 1978-1981.

We describe the behavioral characteristics and sexually transmitted disease (STD) prevalence of Chinese men who have sex with men (MSM) (n = 41) from a national probability sample of men (n = 1861). Most MSM were partnered with females (97%) and had a low rate of consistent condom use (7%). More MSM than heterosexual men self-reported a prior STD and risky sexual behaviors. MSM may act as a bridge for HIV transmission to female partners. Targeted interventions may help prevent a generalized HIV epidemic in China. PMID: 19762670

Wilson, E. C., Garofalo, R., Harris, R. D., Herrick, A., Martinez, M., Martinez, J., et al. (2009). Transgender female youth and sex work: HIV risk and a comparison of life factors related to engagement in sex work. AIDS and Behavior, 13(5), 902-913.

This study examined the HIV risk behaviors and life experiences of 151 transgender female youth, ages 15-24, in Los Angeles and Chicago. Descriptive analyses and logistic regression modeling were used to identify life factors associated with ever having engaged in sex work. Sixty-seven percent of participants had ever engaged in sex work and 19% self-reported being HIV positive. Many factors were significantly associated with sex work for this sample population. A final multivariate logistic regression model found that lower education status, homelessness, use of street drugs, and perceived social support remained significantly associated with sex work when controlling for other factors. Findings highlight the complex HIV risk environment and suggest a need for sex work initiation research for transgender female youth. HIV prevention efforts for this population need to include broad-based approaches that take into account individual, social, and community-level factors relevant to the lives of transgender female youth. PMID: 19199022

 

2008

Cranston, R. D. (2008). Anal cancer prevention: How we are failing men who have sex with men? Sexually Transmitted Infections, 84(6), 417-419. PMID: 19028938

Cranston, R. D., Hirschowitz, S. L., Cortina, G., & Moe, A. A. (2008). A retrospective clinical study of the treatment of high-grade anal dysplasia by infrared coagulation in a population of HIV-positive men who have sex with men. International Journal of STD & AIDS, 19(2), 118-120.

HIV-positive men who have sex with men (MSM) are at high risk of developing human papillomavirus-associated anal squamous cell cancer. Similar to the management of cervical dysplasia, clinicians are treating high-grade anal dysplasia to prevent progression to cancer. Initial treatments such as cold scalpel excision and electrofulguration have shown limited efficacy in a HIV-positive population. Infrared coagulation (IRC) is an outpatient treatment for high-grade anal dysplasia. This retrospective clinical study reports on 68 HIV-positive MSM with 78 biopsy proven high-grade anal lesions. Each lesion was treated with the IRC with re-biopsy of the treatment site a mean of 140 days later. Of the 74 evaluable lesions; 39 had anal intraepithelial neoplasia (AIN) 1, 20 had AIN 2, seven had AIN 3, and eight had normal epithelium. The IRC showed 64% efficacy per treated lesion and shows promise as a treatment modality for high-grade anal dysplasia in this population. PMID: 18334066

D’Souza, G., Wiley, D. J., Li, X., Chmiel, J. S., Margolick, J. B., Cranston, R. D., et al. (2008). Incidence and epidemiology of anal cancer in the multicenter AIDS cohort study. Journal of Acquired Immune Deficiency Syndromes (1999), 48(4), 491-499.

OBJECTIVE: To examine the incidence and risk factors for anal cancer in a multicenter cohort of human immunodeficiency virus (HIV) positive and HIV-negative men who have sex with men followed between 1984 and 2006 (Multicenter AIDS Cohort Study). METHODS: Prospective analysis using Poisson regression and Cox proportional hazard models and a nested case-control study using conditional logistic regression. RESULTS: There were 28 cases of anal cancer among the 6,972 men who were evaluated. The incidence rate was significantly higher in HIV-positive men than in HIV-negative men (incidence rate = 69 vs 14 per 100,000 person-years). Among HIV-positive men, anal cancer incidence was higher in the highly active antiretroviral therapy (HAART) era than the pre-HAART era (incidence rate = 137 vs 30 per 100,000 person-years). In multivariate analysis restricted to the HAART era, anal cancer risk increased significantly with HIV infection (relative hazard = 4.7, 95% confidence interval = 1.3 to 17) and increasing number of unprotected receptive anal sex partners at the first 3 study visits (P trend = 0.03). Among HIV-positive men, current HAART use did not decrease anal cancer risk. CONCLUSIONS: HIV-positive men had increased risk of anal cancer. Improved survival of HIV-positive individuals after HAART initiation may allow for sufficient time for human papillomavirus-associated anal dysplasias to develop into malignancies, thus explaining the increased incidence of anal cancer in the HAART era. PMID: 18614927

Friedman, M. S., Marshal, M. P., Stall, R., Cheong, J., & Wright, E. R. (2008). Gay-related development, early abuse and adult health outcomes among gay males. AIDS and Behavior, 12(6), 891-902.

This study examined relationships between timing of gay-related developmental milestones, early abuse, and emergence of poor health outcomes in adulthood among 1,383 gay/bisexual men in the Urban Men’s Health Study. Latent Profile Analysis grouped participants as developing early, middle or late based on the achievement of four phenomena including age of first awareness of same-sex sexual attractions and disclosure of sexual orientation. Participants who developed early were more likely, compared to others, to experience forced sex and gay-related harassment before adulthood. They were more likely to be HIV seropositive and experience gay-related victimization, partner abuse and depression during adulthood. Early forced-sex, gay-related harassment and physical abuse were associated with several negative health outcomes in adulthood including HIV infection, partner abuse, and depression. This analysis suggests that the experience of homophobic attacks against young gay/bisexual male youth helps to explain heightened rates of serious health problems among adult gay men. PMID: 17990094

Lombardi, E., Silvestre, A. J., Janosky, J. E., Fisher, G., & Rinaldo, C. (2008). Impact of early sexual debut on gay men’s tobacco use. Nicotine & Tobacco Research : Official journal of the Society for Research on Nicotine and Tobacco, 10(11), 1591-1595.

Young men’s sexual experiences with men are different from their sexual experiences with women because of homophobia. Early sexual debut with another man could lead to tobacco use as a result. The study assessed 691 HIV-negative gay men recruited from southwestern Pennsylvania. Early sexual experiences with men and women were associated with participants’ smoking behaviors. It is thought that the early sexual debut with men may place these individuals at risk for homophobia as well as for being socialized in environments that will influence their smoking behavior. To be effective, tobacco control programs need to be culturally competent regarding issues that affect gay men. PMID: 18988071

Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., et al. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction (Abingdon, England), 103(4), 546-556.

AIMS: Several decades of research have shown that lesbian, gay and bisexual (LGB) adults are at high risk for substance use and substance use disorders (SUDs). These problems may often start prior to young adulthood; however, relatively little is known about risk for substance use in LGB adolescents. The primary aims of this paper were to conduct a meta-analysis of the relationship between sexual orientation and adolescent substance use and a systematic review and critique of the methodological characteristics of this literature. METHODS: Medical and social science journals were searched using Medline and PsychInfo. Studies were included if they tested the relationship between sexual orientation and adolescent substance use. Eighteen published studies were identified. Data analysis procedures followed expert guidelines, and used National Institutes of Health (NIH)-sponsored meta-analysis software. RESULTS: LGB adolescents reported higher rates of substance use compared to heterosexual youth (overall odds ratio = 2.89, Cohen’s d = 0.59). Effect sizes varied by gender, bisexuality status, sexual orientation definition and recruitment source. None of the studies tested mediation and only one tested moderation. One employed a matched comparison group design, one used a longitudinal design, and very few controlled for possible confounding variables. CONCLUSIONS: The odds of substance use for LGB youth were, on average, 190% higher than for heterosexual youth and substantially higher within some subpopulations of LGB youth (340% higher for bisexual youth, 400% higher for females). Causal mechanisms, protective factors and alternative explanations for this effect, as well as long-term substance use outcomes in LGB youth, remain largely unknown. PMID: 18339100

Mayer, K. H., Bradford, J. B., Makadon, H. J., Stall, R., Goldhammer, H., & Landers, S. (2008). Sexual and gender minority health: What we know and what needs to be done. American Journal of Public Health, 98(6), 989-995.

We describe the emergence of lesbian, gay, bisexual, and transgender (LGBT) health as a key area of study and practice for clinicians and public health professionals. We discuss the specific needs of LGBT populations on the basis of the most recent epidemiological and clinical investigations, methods for defining and measuring LGBT populations, and the barriers they face in obtaining appropriate care and services. We then discuss how clinicians and public health professionals can improve research methods, clinical outcomes, and service delivery for lesbian, gay, bisexual, and transgender people. PMID: 18445789

McGowan, I., & Anton, P. (2008). Rectal microbicides. Current opinion in HIV and AIDS, 3(5), 593-598.

PURPOSE OF REVIEW: This review will summarize the rationale for developing rectal microbicides and discuss recent developments in the preclinical and clinical evaluation of these products. RECENT FINDINGS: It is clear that heterosexual women often engage in anal intercourse and that men who have sex with men can be found in both the developed and developing world. These observations have catalyzed the need to assess rectal safety of vaginal products and develop rectal specific microbicides. New approaches to the preclinical evaluation of rectal microbicides include the use of transgenic mice, nonhuman primate studies, and human colorectal explant systems. The design of phase I rectal safety studies is becoming increasingly sophisticated, including safety biomarkers to evaluate microbicide-induced immunotoxicity. SUMMARY: There is growing acceptance that all vaginal microbicide candidates moving towards effectiveness studies should be evaluated for rectal safety. In addition, there is increasing awareness of the need to develop rectal specific microbicide formulations.

Rachlin, K., Green, J., & Lombardi, E. (2008). Utilization of health care among female-to-male transgender individuals in the United States. Journal of Homosexuality, 54(3), 243-258.

Female-To-Male (FTM) transgender individuals were approached at a conference and several peer support groups in the United States and asked to complete a short questionnaire regarding their medical care. Results from the 122 completed questionnaires indicated that a high number of respondents were taking testosterone (n = 106) and had some gender-confirming surgery (n = 68). Seventy percent of respondents rated their overall quality of health care “good” or “excellent.” A surprising finding was the low number (7%) reporting diagnoses of polycystic ovarian syndrome–the incidence of which has been reported elsewhere as high as 50%. Also notable were the high levels of employment, insurance, knowledge of standards of care, and access to providers, contrasting with reports from studies involving predominantly Male-To-Female (MTF) individuals. Finally, FTM’s usage of transition-related medical resources can vary, but many within this study are foregoing genital surgery. PMID: 18825862

Stall, R., & Hart, G. (2008). The continuing evolution of research on sexually transmitted infections among men who have sex with men. Sexually Transmitted Infections, 84(6), 407-409. PMID: 19028935;

 

2007

Cranston, R. D., Hart, S. D., Gornbein, J. A., Hirschowitz, S. L., Cortina, G., & Moe, A. A. (2007). The prevalence, and predictive value, of abnormal anal cytology to diagnose anal dysplasia in a population of HIV-positive men who have sex with men. International Journal of STD & AIDS, 18(2), 77-80.

Due to the increasing incidence of anal cancer in HIV-positive men who have sex with men, and the potential to detect and treat high-grade anal dysplasia–the putative anal cancer precursor–we have introduced an anal cytology screening service. Patients with abnormal anal cytology have follow-up high-resolution anoscopy (HRA) with biopsy of lesions clinically suspicious for high-grade dysplasia. In total, 244 men were screened and 235 (96%) of the samples were adequate for cytological interpretation using the Bethesda 2001 system. One hundred and sixty-four (67%) men had abnormal anal cytology, and 93 of them had follow-up HRA and anal biopsy. The positive predictive value for any anal cytological abnormality to predict any degree of anal dysplasia was 95.7+/-2.1%, and for any anal cytological abnormality to predict high-grade anal dysplasia was 55.9+/-5.1%. Abnormal anal cytology was highly predicative of anal dysplasia on biopsy. PMID: 17331275

Crosby, R., Holtgrave, D. R., Stall, R., Peterson, J. L., & Shouse, L. (2007). Differences in HIV risk behaviors among black and white men who have sex with men. Sexually Transmitted Diseases, 34(10), 744-748.

OBJECTIVES: Surveillance findings consistently indicate that black men who have sex with men (MSM) experience a disproportionate burden of HIV/AIDS compared with white MSM. This study tested the hypothesis that black MSM engage in greater levels of HIV risk behaviors than white MSM and sought to determine if self-reported HIV serostatus moderated any of the observed differences. METHODS: A cross-sectional study of MSM was conducted by recruiting men from gay-identified venues in a large metropolitan area of the southern United States. Data were collected by face-to-face interview. RESULTS: The hypothesis was only supported for one measure of HIV risk behavior: The average number of main (steady) sex partners in the past year was significantly greater among black men (P < 0.0001). However, black and white MSM did not significantly differ in unprotected sex with serodiscordant partners. Racial differences in sexual risk behavior were found only for HIV-negative men and indicated greater protective behavior for black men. DISCUSSION: These findings suggest that fewer black MSM, compared with white MSM, engage in HIV sexual risk behaviors but only among HIV-negative men. Identifying the epidemiologic dynamics driving HIV infection among black MSM that go beyond individual-level risk behaviors may be warranted. PMID: 17565334

Garofalo, R., Herrick, A., Mustanski, B. S., & Donenberg, G. R. (2007). Tip of the iceberg: Young men who have sex with men, the Internet, and HIV risk. American Journal of Public Health, 97(6), 1113-1117.

OBJECTIVES: We examined the prevalence of Internet use for meeting sexual partners (Internet partners) and HIV risk behaviors associated with this use among young men who have sex with men (aged 16-24 years). METHODS: A sample of 270 young men who have sex with men completed a computer-assisted survey. We used bivariate chi(2) analyses and hierarchical logistic regression to assess factors associated with Internet-facilitated sexual encounters. RESULTS: Using the Internet to meet sexual partners was common; 48% of our sample had sexual relations with a partner they met online. Of these, only 53% used condoms consistently, and 47% reported having sexual partners older (>4 years) than themselves. Regression analyses showed increased age, White race/ethnicity, history of unprotected anal intercourse, multiple anal intercourse partners, and engaging in sexual activity at a sex club or a bathhouse were associated with meeting sexual partners through the Internet. Only history of unprotected anal intercourse was associated with risky sexual behaviors with Internet partners (P<0.025). CONCLUSIONS: Young men who have sex with men and who seek partners online also engage in other behaviors that place them at risk for HIV and other sexually transmitted infections. PMID: 17463378

Garofalo, R., Mustanski, B. S., McKirnan, D. J., Herrick, A., & Donenberg, G. R. (2007). Methamphetamine and young men who have sex with men: Understanding patterns and correlates of use and the association with HIV-related sexual risk. Archives of Pediatrics & Adolescent Medicine, 161(6), 591-596.

OBJECTIVE: To examine patterns, consequences, and correlates of methamphetamine use among adolescent and young adult men who have sex with men (YMSM). DESIGN: Descriptive, bivariate, and hierarchical regression analyses of cross-sectional data. SETTING: Howard Brown Health Center, a community-based facility in Chicago, Ill, from August 2004 to September 2005. PARTICIPANTS: Three hundred ten YMSM who completed an anonymous, computer-assisted survey. MAIN OUTCOME MEASURE: Methamphetamine use in the past year. RESULTS: Participants ranged in age from 16 to 24 years (mean age, 20.3 years); 30% were white and 70% were of other race/ethnicity (African American, 33%; Hispanic, 26%; Asian or Pacific Islander, 3%; and other, 8%). Participants reported many high-risk sexual and substance use behaviors. Thirteen percent used methamphetamine in the past year. Methamphetamine use was more common among human immunodeficiency virus-infected participants (odds ratio, 2.8; 95% confidence interval, 1.3-5.3) and varied by age and race/ethnicity; substantially higher prevalence was reported by older and non-African American YMSM (P<.001). Compared with other illicit substance users, methamphetamine users reported more memory difficulties, impairments in daily activities, and unintended risky sex resulting from substance use (all P<.01). Hierarchical regression identified sexual risk (unprotected intercourse and multiple partners), sexualized social context (eg, Internet sex, sex in a bathhouse or sex club, sex with older partners, and commercial sex), lower self-esteem, and psychological distress as correlated with methamphetamine use among participants (P<.05). CONCLUSIONS: A substantial percentage of YMSM in this sample used methamphetamine. Methamphetamine use is a public health problem with significant implications for the health and well-being of YMSM. Methamphetamine use was associated with human immunodeficiency virus-related risk, and patterns of use were predicted by demographic data, sexualized social contexts, and psychological variables. PMID: 17548765

Lombardi, E. (2007). Substance use treatment experiences of transgender/transsexual men and women. Journal of LGBT Health Research, 3(2), 37-47.

Substance use treatment programs may not be sensitive to transgender/transsexual (trans) issues: thus, the needs of drug/alcohol involved trans men and women may go unmet. Data for this research was collected from a study examining the substance use issues of trans men and women. Confidential, self-administered questionnaires were distributed to trans men and women with current or previous problem (self-assessed) with drugs or alcohol. Trans individuals reported various problems with discrimination that may limit their ability to recover. Overall, there were significant barriers to recovery expressed by the study participants. Treatment and self-help programs need to make their programs more inclusive to trans men and women as the negative experiences experienced by them will likely affect their recovery.

Moyer, M B, Silvestre, A.J., Lombardi, E.L., Taylor, C.A.(Spring/Summer 2007) High-Risk Behaviors Among Youth and Their Reasons for Not Getting Tested for HIV.  Journal of HIV/AIDS Prevention in Children & Youth 8:1, 59-73.

Concerned about reports of a 15% decline in HIV testing among high-risk youth in an earlier study in Pittsburgh, this study was initiated to explore reasons why young people are not getting tested for HIV, while gathering data on their respective level of risk taking behaviors. A total of 580 surveys were collected from youth aged between 14 and 24. Overall, 17% of youth were found to be at high to some risk for HIV infection, while many of them agreed they were not at-risk for HIV. Young MSM reported being afraid of testing HIV positive. Young people continue to engage in high-risk behaviors and avoid HIV testing, and efforts are needed to identify these youth and equip them with the resources they need to avoid infection.

Mustanski, B., Garofalo, R., Herrick, A., & Donenberg, G. (2007). Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention. Annals of Behavioral Medicine : A Publication of the Society of Behavioral Medicine, 34(1), 37-45.

BACKGROUND: Young men who have sex with men (YMSM) experience disparities in HIV rates and potentially in mental health, substance abuse, and exposure to violence. PURPOSE: We assessed the extent to which these psychosocial health problems had an additive effect on increasing HIV risk among YMSM. METHODS: An urban sample of 310 ethnically diverse YMSM reported on psychosocial health problems, sexual risk behaviors, and HIV status. A count of psychosocial health problems was calculated to test the additive relationship to HIV risk. RESULTS: The prevalence of psychosocial health problems varied from 23% for regular binge drinking to 34% for experiencing partner violence. Rates of sexual risk behaviors were high and 14% of YMSM reported receiving a HIV+ test result. Psychosocial health problems cooccurred, as evidenced by significant bivariate odds ratios (ORs) between 12 of the 15 associations tested. Number of psychosocial health problems significantly increased the odds of having multiple anal sex partners (OR=1.24), unprotected anal sex (OR=1.42), and an HIV-positive status (OR 1.42), after controlling for demographic factors. CONCLUSIONS: These data suggest the existence of cooccurring epidemics, or “syndemic,” of health problems among YMSM. Disparities exist not only in the prevalence of HIV among YMSM but also in research to combat the epidemic within this vulnerable population. Future research is needed to identify risk and resiliency factors across the range of health disparities and develop interventions that address this syndemic. PMID: 17688395

Plankey, M. W., Ostrow, D. G., Stall, R., Cox, C., Li, X., Peck, J. A., et al. (2007). The relationship between methamphetamine and popper use and risk of HIV seroconversion in the Multicenter AIDS Cohort Study. Journal of Acquired Immune Deficiency Syndromes (1999), 45(1), 85-92.

BACKGROUND: The association between methamphetamine use and HIV seroconversion for men who have sex with men (MSM) was examined using longitudinal data from the Multicenter AIDS Cohort Study. METHODS: Seronegative (n = 4003) men enrolled in 1984 to 1985, 1987 to 1991, and 2001 to 2003 were identified. Recent methamphetamine and popper use was determined at the current or previous visit. Time to HIV seroconversion was the outcome of interest. Covariates included race/ethnicity, cohort, study site, educational level, number of sexual partners, number of unprotected insertive anal sexual partners, number of unprotected receptive anal sexual partners, insertive rimming, cocaine use at the current or last visit, ecstasy use at the current or last visit, any needle use since the last visit, Center for Epidemiologic Study of Depression symptom checklist score >16 since the last visit, and alcohol consumption. RESULTS: After adjusting for covariates, there was a 1.46 (95% confidence interval [CI]: 1.12 to 1.92) increased relative hazard of HIV seroconversion associated with methamphetamine use. The relative hazard associated with popper use was 2.10 (95% CI: 1.63 to 2.70). The relative hazard of HIV seroconversion increased with the number of unprotected receptive anal sexual partners, ranging from 1.87 (95% CI: 1.40 to 2.51) for 1 partner to 9.32 (95% CI: 6.21 to 13.98) for 5+ partners. The joint relative hazard for methamphetamine and popper use was 3.05 (95% CI: 2.12 to 4.37). There was a significant joint relative hazard for methamphetamine use and number of unprotected receptive anal sexual partners of 2.71 (95% CI: 1.81 to 4.04) for men with 1 unprotected receptive anal sexual partner, which increased in a dose-dependent manner for >1 partners. CONCLUSIONS: Further examination of the mechanisms underlying the synergism of drug use and sexual risk behaviors on rates of HIV seroconversion is necessary for the development of new targeted HIV prevention strategies for non-monogamous drug-using MSM. PMID: 17325605

Stall, R. (2007). Opportunities to improve AIDS prevention practice among men who have sex with men. American Journal of Preventive Medicine, 32(4 Suppl), S29-30. PMID: 17386332;

Teti, M., Bowleg, L., Rubinstein, S., Lloyd, L., Berhane, Z., & Gold, M. (2007). Present but not accounted for: Exploring the sexual risk practices and intervention needs of nonheterosexually identified women in a prevention program for women with HIV/AIDS. Journal of LGBT Health Research, 3(4), 37-51.

Nonheterosexually identified (NHI) women may be present, but not accounted for, in HIV and sexually transmitted infection (STI) prevention interventions. This study used quantitative and qualitative methods to examine the sexual risk behaviors and intervention needs of NHI women in Protect and Respect, a safer sex intervention for HIV-positive women. Study participants (n=32) were predominantly Black, low income, and between 28 and 51 years old. Although NHI participants were more likely than heterosexual participants (p < .05) to report obtaining their income from sex work, hustling, or selling drugs; and having a higher median number of male sex partners, qualitative analyses revealed that the intervention often neglected NHI women’s experiences and unique safer sex needs. Heterosexist HIV and STI prevention programs may hinder NHI women’s ability to protect themselves and their partners from reinfection and infection respectively. We discuss the implications of our research for future HIV/AIDS and STI research, services and interventions for NHI women.


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