Census Tract Poverty and Racial Disparities in HIV Rates in Milwaukee County, Wisconsin, 2009-2014.

Previous work has documented associations between poverty and HIV. Understanding of these relationships at local levels could help target prevention efforts; however, HIV surveillance systems do not capture individual-level poverty measures. We utilized the Public Health Disparities Geocoding Project methods to examine HIV rates by census tract poverty. HIV rates and rate ratios were computed by census tract poverty (< 5.0, 5.0-9.9, 10.0-19.9, > 20.0% of individual below the federal poverty level) for all races and stratified by Black and White race using Poisson regression. We observed higher HIV rates in the highest poverty gradient compared to the lowest poverty gradient for all races combined and among White cases. After adjustment, HIV rates were similar across poverty gradients for all comparisons. Our findings suggest that the association between poverty and HIV may differ by subpopulation, while demonstrating the potential for HIV prevention targeting residents of high poverty areas.

Unhealthy environments, unhealthy consequences: Experienced homonegativity and HIV infection risk among young men who have sex with men.

Unfavourable social environments can negatively affect the health of gay, bisexual, and other men who have sex with men (MSM). We described how experienced homonegativity - negative perceptions and treatment that MSM encounter due to their sexual orientations - can increase HIV vulnerability among young MSM. Participants (n = 44) were young MSM diagnosed with HIV infection during January 2006-June 2009. All participants completed questionnaires that assessed experienced homonegativity and related factors (e.g. internalised homonegativity). We focus this analysis on qualitative interviews in which a subset of participants (n = 28) described factors that they perceived to have placed them at risk for HIV infection. Inductive content analysis identified themes within qualitative interviews, and we determined the prevalence of homonegativity and related factors using questionnaires. In qualitative interviews, participants reported that young MSM commonly experienced homonegativity. They described how homonegativity generated internalised homonegativity, HIV stigma, silence around homosexuality, and forced housing displacement. These factors could promote HIV risk. Homonegative experiences were more common among young Black (vs. non-Black) MSM who completed questionnaires. Results illustrate multiple pathways through which experienced homonegativity may increase HIV vulnerability among young MSM. Interventions that target homonegativity might help to reduce the burden of HIV within this population.

Evaluation of the Acceptance Journeys Social Marketing Campaign to Reduce Homophobia.

OBJECTIVES: To evaluate the effectiveness of the Acceptance Journeys social marketing campaign to reduce homophobia in the Black community in Milwaukee, Wisconsin. METHODS: We assessed the campaign's effectiveness using a rolling cross-sectional survey. Data were collected annually online between 2011 and 2015. Each year, a unique sample of Black and White adults, aged 30 years and older, were surveyed in the treatment city (Milwaukee) and in 2 comparison cities that did not have antihomophobia campaigns (St. Louis, MO, and Cleveland, OH; for total sample, n = 3592). RESULTS: Black self-identification and Milwaukee residence were significantly associated with exposure to the campaign, suggesting successful message targeting. The relationship between exposure and acceptance of gay men was significantly mediated through attitudes toward gay men, perceptions of community acceptance, and perceptions of the impact of stigma on gay men, but not through rejection of stereotypes. This model accounted for 39% of variance in acceptance. CONCLUSIONS: This evidence suggests that the Acceptance Journeys model of social marketing may be a promising strategy for addressing homophobia in US Black communities.

HIV stigma experienced by young men who have sex with men (MSM) living with HIV infection.

Stigma can compromise the health of persons living with HIV. Although HIV is increasingly affecting young men who have sex with men (MSM), little is known about their experiences with HIV stigma. We used narrative data to examine HIV stigma experienced by young MSM living with HIV. Data came from 28 qualitative interviews with young MSM. We used inductive content analysis to identify themes across these interviews. Participants commonly discussed negative perceptions and treatment of persons living with HIV. Stigma could result in nondisclosure of HIV status, internalized stigma, and avoidance of HIV-related things. Some men discussed strategies that might combat stigma. Findings suggest that HIV stigma might challenge young MSM's health by undermining health-conducive resources (e.g., social support) and contributing to HIV vulnerability. Interventions that counteract HIV stigma may help to create environments that promote well-being among young MSM living with HIV.

Social Network Diagramming as an Applied Tool for Public Health: Lessons Learned From an HCV Cluster.

OBJECTIVES: We present an applied example of social network diagramming from 2010 to 2012 that was used to guide follow-up in a large HCV cluster in rural Wisconsin. METHODS: In addition to collecting standard individual-level attributes, we also obtained partner-level information. Both sets of data were input into a network diagramming program to create a series of diagrams that emphasized variables, such as risk factors, key location in the network, and number of partners. RESULTS: The visualization and cluster analysis guided testing and intervention priorities, were useful in sharing de-identified information about the cluster between health departments and community organizations and illustrated the key role young females played in holding the cluster together. CONCLUSIONS: Social network diagramming should be considered a practical and important public health tool for use in cluster management.

An exploration of religion and spirituality among young, HIV-infected gay and bisexual men in the USA.

Although religion and spirituality can promote healthy behaviours and mental well-being, negative religious experiences may harm sexual minority men's health. Despite increasing vulnerability to HIV infection among young gay and bisexual men, few studies examine how religion and spirituality might affect them. To this end, we interviewed young gay and bisexual men who were diagnosed with HIV infection during January 2006-June 2009. Questionnaires assessed religious service attendance, disclosure of sexuality within religious communities, and beliefs about homosexuality being sinful. A subset described religious and spiritual experiences in qualitative interviews. We calculated the prevalence of religion- and spirituality-related factors and identified themes within qualitative interviews. Among men completing questionnaires, 66% currently attended religious services, 16% believed they could disclose their sexuality at church, and 37% believed homosexuality was sinful. Participants who completed qualitative interviews commonly discussed religious attendance and negative experiences within religious settings. They often expressed their spirituality through prayer, and some used it to cope with adverse experiences. These data suggest that religion and spirituality are notable factors that shape young, HIV-infected gay and bisexual men's social contexts. Programmes and interventions that constructively engage with religious institutions and are sensitive to spiritual beliefs may promote these men's health.

HIV prevalence estimates and alignment among recent diagnoses, targeted tests, and prevention services by demographic and racial/ethnic group in Wisconsin.

The article provides HIV prevalence estimates by demographic group (men who have sex with men [MSM], non-MSM males, and females) and race/ethnicity for Wisconsin. Using the estimate that 4-8% of males aged 15-59 are MSM, we estimate that 14-28% of Black MSM in Wisconsin are HIV-positive. The proportions of HIV diagnoses by racial/ethnic and demographic group were compared with the proportions of targeted tests and HIV prevention clients in 2009. Among Blacks, MSM accounted for 58% of HIV diagnoses in Wisconsin but only 19% of targeted tests and 11% of HIV prevention clients. Disparities between cases and services also exist for Latinos and Whites. Jurisdiction-level testing targets were developed for 2010 using the estimated number of persons presumed to be living with HIV and unaware of their infection by racial/ethnic and demographic group. Targets for 2010 were compared with targeted tests conducted in 2009 to identify groups with the largest discrepancies.

Epidemiologic trends in infection, mortality, and transplants related to hepatitis C in Wisconsin.

Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States. An estimated 3.9 million persons nationally and 85,000 persons in Wisconsin are currently infected. The disease is responsible for approximately 8000 to 10,000 deaths nationally each year. This article summarizes epidemiologic trends in infection, mortality and transplants related to HCV in Wisconsin. It presents surveillance data collected during 1997-2004; HCV-related deaths during 1995-2002, with HCV as an underlying or contributing cause of death; and data for liver transplants related to HCV between 1993 and 2004. During the time periods reviewed, there were 16,668 cases of HCV infection reported, 1186 HCV-related deaths, and 356 HCV-related liver transplants involving HCV in Wisconsin. Infection rates and related adverse health outcomes related to HCV are highest in males, persons ages 35-64, Milwaukee residents, and inmates in the state correctional system. African Americans have high rates of morbidity (24% of cases) and mortality (16% of decedents), but are under-represented among recipients of HCV-related transplants (6% of recipients).

Using Web-based reporting systems to evaluate health promotion: the experience of two statewide HIV prevention programs.

While Web-based reporting systems are becoming more common in public health for disease surveillance and for tracking interventions such as immunizations, their use for program evaluation is relatively new. This article describes two Web-based reporting systems developed to enable local agencies that conduct health promotion activities to enter process and outcome data for their own use, as well as for analysis by researchers and funders. The systems support the three major uses of evaluation: accountability, program improvement, and generating knowledge for the field. Annually, these programs obtain evaluation information on thousands of clients and individual and group sessions. Developing and introducing the Web-based systems was time-consuming and required significant State Health Department and local agency resources. Involvement of end users in the development process was critical to creating responsive systems that were accepted by staff in local agencies. Staff members from grantee agencies responded well to systems, as evidenced by high rates of user compliance (over 90%) and positive reactions (over 80%) on anonymous surveys. Concerns about resistance from contractors to use of the system, based on fears about breaches in client confidentiality or concerns about the difficulty in using the technology, were not borne out.

Reductions in transmission risk behaviors in HIV-positive clients receiving prevention case management services: findings from a community demonstration project.

Prevention case management (PCM) for HIV-infected persons is an HIV risk reduction intervention designed to assist clients who are aware of their HIV infection and who continue to engage in risk transmission behaviors. PCM combines individual risk reduction counseling with case management to address the psychosocial factors affecting HIV transmission. More than 350 HIV-positive clients participated in PCM in Wisconsin between 2000 and 2003, and 109 completed both baseline and follow-up risk assessments. The percentage of clients reporting risk transmission behaviors, specifically unprotected vaginal intercourse, insertive anal intercourse, or needle sharing with partners of negative or unknown HIV status, declined from 41.3% at baseline to 29.4% at follow-up (p = 0.04). Furthermore, clients showed progression (p < or =.05) through stages of change using Prochaska and DiClemente's transtheoretical model on seven domains related to HIV transmission risk, including personalizing risk of HIV transmission and sexual risk behavior.