Abstract
Project IN-CARE: Impact of mental health and substance use on viral load suppression in an MSM population
Amy Johnson, PhD, MSW1 and Roman Buenrostro2
(1)Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, (2)AIDS Foundation of Chicago, Chicago, IL
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
The AIDS Foundation of Chicago implemented a coordinated peer-health navigation program targeting HIV-positive men who have sex with men of color in Chicago. The goal of the program was to increase retention in medical care via peer support and navigation.
720 participants were enrolled in the program. Baseline data revealed high rates of mental health (MH) (60%) and substance abuse (SA) symptomatology (61%). Bivariate analysis demonstrated that there are associations between MH and viral load suppression, with those reporting MH issues less likely to achieve viral load suppression than those who did not report MH issues; likewise those reporting SA were less likely to achieve viral load suppression than those who did not. Engagement in the peer program was positively associated with viral suppression and negatively associated with SA and MH.
Our findings indicate peer interventions should incorporate material to address coping with SA and MH, assessing readiness for SA and MH treatment, and linkage/support for treatment as a means to increase medication adherence and retention in care. Peer health programs designed to retain patients living with HIV should ensure that proper SA/MH training, support and access to clinicians is available to staff and clients.
Conduct evaluation related to programs, research, and other areas of practice Program planning Provision of health care to the public Public health or related research
Abstract
“She is like a Mother to Me”: Perspectives on patient-provider relationship from Ghanaian men who have sex with me (MSM) living with HIV
Adedotun Ogunbajo, MPH, MHS, PhDc1, Trace S. Kershaw, PhD2, Sameer Kushwaha3, Francis Boakye4, Nii-Dromo Wallace-Atiapah4 and LaRon Nelson, PhD, RN, NP5
(1)Brown School of Public Health, Providence, RI, (2)Yale University, New Haven, CT, (3)University of Toronto Faculty of Medicine, Toronto, ON, Canada, (4)Priorities on Rights and Sexual Health, Accra, Ghana, (5)University of Rochester School of Nursing, Rochester, NY
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
background: In Ghana, men who have sex with men (MSM) bear a high burden of the HIV/AIDS epidemic. To date, no studies have explored how patient-provider interactions might influence the health experience and outcomes for Ghanaian MSM living with HIV. This qualitative study aims to fill this gap in the literature by exploring the dynamics perspectives of patient-provider relationships among HIV-positive adult Ghanaian MSM.
methods: Between May and July 2015, participants were recruited through referral from three key informants and subsequent snowball sampling. In-depth, face-to-face interviews were conducted with 30 HIV-positive MSM living in Accra, Ghana. Interviews explored participants’ relationship with healthcare providers, instances of positive and/or negative encounters with providers, and openness about sexual orientation. Interviews were transcribed verbatim and subjected to qualitative content analysis using qualitative analysis software (NVivo 10), based on constant comparison approach.
results: The average age of participants was 29.1 years (S.D. = 7.7). Overall, participants described positive relationships with healthcare providers. Providers were frequently referred to as a second “mother”, having fostered a trusting and close relationship with participants over time. However, participants recounted negative encounters with providers due to concerns about confidentiality of HIV status and treatment regimen, inadequate time during clinical visits, and negative messages surrounding sexual orientation, gender identity and sexual behavior.
conclusions: These findings suggest that the strengthening of connections between healthcare providers and people living HIV should be prioritized, both at the interpersonal level of provider-patient interactions but also at the health system organizational level.
Chronic disease management and prevention Public health or related research
Abstract
Outcome expectancy and sexual compulsivity among men who have sex with men living with HIV: Disparities by age and sexual orientation
Monique J. Brown, PhD, MPH1, Julianne M. Serovich, PhD2 and Judy A. Kimberly, PhD2
(1)University of South Carolina, Columbia, SC, (2)University of South Florida, Tampa, FL
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: Outcome expectancy (OE) is the belief about specific consequences that may result due to certain behaviors. OE may be linked to sexual compulsivity (SC), however, studies examining disparities by age group and sexual orientation among MSM living with HIV are lacking.
Objective: To assess disparities by age and sexual orientation in the association between OE and SC among MSM living with HIV.
Methods: Data were obtained from 338 MSM living with HIV. Interactions between OE and age, and between OE and sexual orientation were tested. Multiple linear regression was used to determine the associations between self-efficacies for condom use, disclosure, and negotiation of safer sex practices, and SC for gay and bisexual men separately, and for MSM aged 18-34, 35-49 and ≥50 years.
Results: No statistically significant differences emerged in the associations between OE and sexual compulsivity by sexual orientation. However, disparities in the association between OE and SC were seen by age. After adjusting for race/ethnicity, education, income, employment, and time since diagnosis, among MSM aged 18-34 and 35-49, every unit increase in OE for condom use was associated with a one-unit decrease in SC (β: -1.02; 95% CI: -1.72, -0.31, β: -1.00, 95% CI: -1.51, -0.50, respectively). Among MSM aged 35-49, every unit increase in OE for HIV disclosure and negotiation of safer sex practices was also associated with a one-unit decrease in SC.
Conclusions: Intervention programs aimed at reducing SC among MSM living with HIV are warranted and should address OEs and consider age differences.
Social and behavioral sciences
Abstract
Latent Classes of Sexual Risk among Black Men Who Have Sex with Men and Women
Derek Dangerfield II1, Nina Harawa, PhD, MPH2, Laramie Smith, PhD3, Lourdes Baezconde Garbanati, PhD, MPH, MA1 and Ricky N. Bluthenthal, Ph.D.4
(1)University of Southern California, Los Angeles, CA, (2)Charles Drew University of Medicine and Science, (3)University of California San Diego, La Jolla, CA, (4)Keck Medicine, University of Southern California, Los Angeles, CA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Introduction: Black men who have sex with men and women (BMSMW) are at high risk for HIV and sexually transmitted infections (STIs). Despite knowing that HIV/STI risk varies according to sexual positioning practices, limited data have characterized the risk profiles of BMSMW. This study utilized latent class analysis (LCA) to explore BMSMW’s sexual risk profiles regarding condomless sexual positioning practices.
Methods: LCA was used to reveal underlying sexual risk profiles of BMSMW in Los Angeles, Chicago, and Philadelphia. Age, study location, HIV status, social support, and internalized homophobia were used as covariates in a multinomial regression to predict the likelihood of class membership.
Results: Among the 546 participants, three latent classes of risk were identified: High Risk, Moderate Risk, and Low Risk. BMSMW with High Risk membership had greater probabilities of condomless sex with main male and main female partners, and HIV-positive casual partners. BMSMW with Moderate Risk membership had higher probabilities of condomless sex with HIV-negative or unknown status casual partners. Low Risk members had lower probabilities for condomless sex across all sexual positioning practices. BMSMW with High Risk class membership were 3.4 times as likely to be HIV-positive versus HIV-negative or status unknown (OR=3.42, 95% CI=1.82, 6.42).
Conclusion: Findings suggest that BMSMW have varying sexual risk for HIV/STIs. Studies should further explore these nuanced risk behaviors of sexual positioning. With better understanding of sexual risk behaviors among Black MSMW, interventions will be more suited for addressing HIV/STIs among Black MSMW and their sexual partners.
Assessment of individual and community needs for health education Public health or related research Social and behavioral sciences
Abstract
Trust the process: Identifying psychosocial pathways between stigma & medical mistrust in newly diagnosed HIV positive MSM
Miranda Iverson Hill, MPH1, Jacqueline Newbold1, Natalia Truszczynski, MPH1, Robert Coffman, MPH1, Nathan Hansen, PhD1, Patrick Wilson, PhD2 and Lindsay White, MSW1
(1)University of Georgia, Athens, GA, (2)Columbia University, New York, NY
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background:Patient-provider trust is essential to continuity of care among HIV-positive Men who have Sex with Men (MSM). Unfortunately, medical mistrust is a prevalent barrier to optimal treatment outcomes among this population. While research shows stigma to strongly predict mistrust, knowledge regarding the mechanisms linking stigma and mistrust is limited. We investigated the potential mediating roles of social support and coping between stigma and mistrust. Methods: A secondary analysis of data consisting of newly diagnosed MSM recruited in New York was conducted. The majority of participants (N=200) identified as Black (41%) or Hispanic (26%), male (96%), and gay (86%), with a mean age of 32 years. We used Hayes Process tool (SPSSv.24) to conduct mediation analyses evaluating the effects of social support and coping on the relationship between stigma and medical mistrust. Results:Social support had an indirect effect on the relationships between stigma and mistrust (race-(2 = .0277, BCa CI [.0004, .0650] and sexual orientation-based mistrust (2 = .0665, BCa CI [.0097, .1520])). Similarly, disengagement coping had an indirect effect on the relationships between stigma and mistrust (race-(2 = .2104, BCa CI [.0491, .3801]) and sexual orientation-based mistrust (2 = .0958, BCa CI [0.0544, 0.3823])). Conclusions:The results identify social support and disengagement coping as potential mediators between stigma and medical mistrust. The results contribute knowledge to efforts aimed at intervening on the harmful effects of stigma. The implications of these results extend to research aimed at understanding leverage points for strengthening relationships between MSM and formalized HIV care networks.
Provision of health care to the public Public health or related research
Abstract
Title: HIV Testing Behaviors of High School MSM and MSW: Pooled Analysis of 2015 Youth Risk Behavior Survey Data
Blair Turner, MPH, Rachel Marro and Gregory Phillips II, PhD, MS
Northwestern University, Chicago, IL
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background:
In 2015, youth aged 13 to 24 years accounted for 22% of all new HIV diagnoses in the United States. Among youth, 81% diagnosed were men who have sex with men (MSM). The CDC recommends that all males 13 to 24 get tested for HIV; however, little is known about HIV testing behaviors among high school students, particularly MSM.
Methods:
We analyzed pooled 2015 Youth Risk Behavior Survey (YRBS) data to assess HIV testing prevalence among 19,079 high school males. Weighted logistic regression was used to calculate odds of HIV testing comparing MSM to men who have sex with women (MSW). Sub analyses were then conducted among males to look at associations with HIV risk behaviors.
Results:
More than one-fifth (21.8%) of male high school students reported ever being tested for HIV. MSM were significantly more likely to report a lifetime test compared to MSW (OR: 2.11, 95% CI: 1.58, 2.82). Among male students who had four or more partners and among male students who reported no condom use at last sex, MSM were significantly more likely to report testing for HIV than MSW (respectively, OR: 2.41, 95% CI: 1.55, 3.74 ; OR: 2.41, 95% CI: 1.55, 3.74).
Conclusions:
High school-aged MSM were more likely to have tested for HIV than MSW. However, the prevalence of HIV testing remains low among high school males, regardless of sexual behavior. These data suggest that further efforts are needed to increase HIV testing rates among high school males.
Epidemiology Public health or related research
Abstract
Barriers to use of pre-exposure prophylaxis for the prevention of HIV among men who have sex with men (MSM) in a relatively rural state
Randolph Hubach, PhD, MPH1, Joseph Currin, PhD2, Carissa Sanders3, Katherine Kavanaugh, MS3, Andre Durham, MEd3, Denna Wheeler, PhD4 and Julie M. Croff, PhD, MPH4
(1)Oklahoma State University-Center for Health Sciences, Tulsa, OK, (2)Texas Tech University, Lubbock, TX, (3)Oklahoma State University, Stillwater, OK, (4)Oklahoma State University Center for Health Sciences, Tulsa, OK
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: Biomedical intervention approaches including antiretroviral pre-exposure prophylaxis (PrEP) have been demonstrated to reduce HIV incidence among several at-risk populations and to be cost effective. HIV transmission can be significantly reduced through comprehensive biomedical that include holistic behavioral intervention targeting at-risk groups. However, there is limited understanding of PrEP uptake among men who have sex with men (MSM) residing in relatively rural states.
Methods: We used a grounded theory design and recruited 25 MSM residing in Oklahoma for in-depth qualitative interviews. Utilizing an inductive approach, we explored patterns of sexual relationships, sexual partner-seeking behavior, determinants of sexual risk, attitudes towards PrEP, and facilitators and barriers to PrEP uptake.
Results: Participants perceived substantial barriers to adopting PrEP including a stigmatizing social environment and less access to quality, LGBT-sensitive medical care. Structural issues, including lack of comprehensive sexual health education, within the state of Oklahoma were noted. In particular, participants indicated they utilized both social and sexual networking sites as a method to acquire sexual health-related information. PrEP emerged as a contentious issue because of a lack of desire to discuss their sexual behavior or sexual orientation with their medical practitioners, fearing rejection from a provider.
Conclusions: Geographic isolation limits access to health and social service providers that support sexual health for Oklahoma MSM. Addressing stigma situated across ecological levels in an effort to increase adoption of PrEP by MSM residing in rural states remains necessary. Without this, social determinants may continue to negatively influence PrEP adoption and sexual health outcomes.
Diversity and culture Public health or related research Social and behavioral sciences
Abstract
Comparing MSM on PrEP to those who meet CDC guidance for PrEP use, but are not taking it: Results from a U.S. National Sample
Kristina Rodriguez, DPH, MPH1, Elizabeth Kelvin, PhD, MPH2, Jeffrey Parsons, PhD and Christian Grov, PhD, MPH4
(1)CUNY Graduate School of Public Health and Health Policy, New York, NY, (2)CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, (3)CUNY Graduate School of Public Health and Health Policy, and the Center for HIV/AIDS Educational Studies and Training, New York, NY
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: PrEP uptake among men who have sex with men (MSM) in US remains slow. Apart from demonstration studies, there is little research on factors associated with PrEP use among geographically diverse samples.
Methods: In 2016, 2,597 HIV-negative MSM from across the US completed surveys about sexual behavior and PrEP use. Men were recruited via a variety of sources (e.g., social media, hook-up app, hook-up website). Participants were categorized as:1)those on PrEP (17.6%), 2)those who met CDC guidance for PrEP but didn’t use (56.9%), and 3)those not meeting CDC guidance nor on PrEP (16.5%). Logistic regression with GEE was used to compare those who met CDC guidance for PrEP treatment but weren’t taking versus those taking PrEP.
Results: Participants from the Midwest (OR=0.6,p=0.008) and South (OR=0.6,p=0.006) had lower odds of PrEP use as compared to the West. Participants with higher education, both 4-year college (OR=2.0,p=0.001) and graduate school (OR=1.9,p=0.005), and recent STD (OR=1.8,p<0.001) had higher odds of taking PrEP compared to participants with less education and no STD respectively. Lastly, participants identifying as bisexual (OR=0.5,p<0.001) and “other” (OR=0.3,p=0.021), those reporting sex with women (OR=0.3,p =0.028) or multiple partners (OR=0.2,p<0.001) had lower odds of taking PrEP.
Conclusions: More than half of participants met CDC guidance for PrEP treatment but weren’t taking PrEP. Lower education, geography and sexual behavior were associated with non-PrEP use. MSM from the South and Midwest—where the HIV epidemic is high—were less likely to use, suggesting residence/geography may be a determinant in uptake.
Provision of health care to the public Public health or related education Public health or related laws, regulations, standards, or guidelines Public health or related research Social and behavioral sciences
Abstract
Evaluating the feasibility, acceptability, and initial efficacy of a Pre-Exposure Prophylaxis knowledge mobile app for young men who have sex with men (YMSM)
Brandon Hill, PhD1, Trevor Bak, BA2, John Schneider, MD, MPH2, Julia Rosebush, DO2 and Matthew Richards, LCSW, MDiv2
(1)Planned Parenthood Great Plains, Overland Park, KS, (2)University of Chicago, Chicago, IL
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Although Pre-Exposure Prophylaxis (PrEP) is approved for use among eligible adults 18 years and older, PrEP awareness, knowledge, and uptake has been relatively low, Black young men who have sex with men (YMSM). To address this gap we developed a mobile PrEP knowledge app—miPrEP. The miPrEP app was developed and designed with a 6 member community advisory board (CAB) composed of Black YMSM (ages 18-24) to ensure cultural sensitivity and relevance. Next, the app was tested with 60 YMSM (ages 18-24) attending a mobile health unit for STI/HIV screening to assess feasibility, acceptability, and preliminary efficacy of miPrEP. Participants rated miPrEP as feasible and acceptable to use, with 83.4% of agreeing they would recommend miPrEP to friends or partners. Pre-/post- assessments revealed a significant increase in PrEP content knowledge and comprehension scores (57.3 vs. 79.5, p<.001). Additionally, participants reported an increase in knowing “how PrEP is supposed to be taken” (p=.005), “the possible side effects of PrEP” (p<.001), understanding “how PrEP works in the body to prevent HIV infection” (p<.001), and how “PrEP interacts with alcohol and other drugs” (p=.004) post-intervention, compared to baseline. Participants were significantly less likely to report “worry that taking PrEP will hurt my health” (p=.04) after using miPrEP. Our findings indicate that miPrEP is a feasible and acceptable way to build PrEP awareness and knowledge among Black YMSM attending a mobile health unit for STI/HIV screening. Additionally, participants increased their comprehensive knowledge about PrEP after using the miPrEP app.
Planning of health education strategies, interventions, and programs Provision of health care to the public Social and behavioral sciences
Abstract
Stakeholder analysis of structural and systemic factors driving the HIV/AIDS epidemic in Miami, Florida
Tracy Pugh, MHS1, Pedro C. Castellon, MPH2, Allan Rodriguez, MD3 and Lisa R. Metsch, PhD4
(1)Mailman School of Public Health at Columbia University, New York, NY, (2)Columbia University, Miami, FL, (3)University of Miami Miller School of Medicine, Miami, FL, (4)Columbia University, New York, NY
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: Miami, Florida persists as an epicenter of HIV/AIDS nationally. The stagnated progress in improving HIV outcomes reveals a need for a more comprehensive understanding of HIV/AIDS that incorporates insight from actors within the systems affecting people with HIV/AIDS. The purpose of this study is to use a stakeholder analysis approach to understand the complexity of driving factors and key challenges Miami has been facing in this epidemic.
Methods: Between 09/2016- 10/2016, a stakeholder analysis was conducted through the implementation of 11 focus groups (64 participants) with frontline workers including community health workers and case managers. Data were collected through note-taking and audio recordings, and analyzed using qualitative software for thematic analysis of the transcripts.
Results: Participants identified driving factors of the HIV/AIDS epidemic. Common themes that arose from the focus groups highlighted systemic barriers regarding: HIV prevention; treatment access, initiation and care; ancillary service gaps; and community and government roles. Stigma surrounding HIV/AIDS and populations affected was repeatedly discussed throughout the conversations. Housing was a major service need commonly identified. Fragmentation of social service systems was viewed as improving but still hindered by persistent gaps. Political climate and healthcare investment were also specified as critical structural factors effecting HIV/AIDS outcomes.
Conclusions: Integral to this study was learning from stakeholders about the internal hurdles of program and policy implementation from the perspective of providers on the ground. Obstacles to improving HIV/AIDS outcomes endure across social systems, and through structural factors impacting access, public attitudes, policy making, and service delivery.
Administration, management, leadership Advocacy for health and health education Other professions or practice related to public health Program planning Public health administration or related administration Public health or related public policy