The role of social support networks in a sample of older adults living with HIV: the GOLD studies.

As the epidemiological landscape of HIV/AIDS changed over the last 40 years, more people are now living with HIV/AIDS deeper into senior adulthood. People over age 50 living with HIV face myriad challenges including medical, psychological, and social comorbidities. In this analysis, we consider the social realities and social networks of older adults living with HIV and assess how relationships and communities have been affected by stigma and other challenges of aging with HIV. A total of 40 participants, ages 51-69 years, living with HIV in the Newark metropolitan area were interviewed. A thematic analysis was conducted, and four main themes were identified: (1) friends and relationships; (2) support groups; (3) stigma and discrimination; (4) family. The role of social support within this community is discussed within these key themes. This study helps us to better understand how support networks affect older adults living with HIV and how stigma and fragmented relationships can ultimately contribute to negative health outcomes.

Intimate Partner Violence and Mental Health Among Transgender and Gender Diverse Young Adults.

Purpose: Research indicates that multiple forms of intimate partner violence (IPV) may be prevalent among transgender and gender diverse (TGD) people, including general forms of IPV (psychological, physical, sexual), as well as identity-specific forms (transgender-related IPV (T-IPV), identity abuse (IA)). Studies also suggest that IPV is associated with negative mental health outcomes in TGD populations, including depression, anxiety, and posttraumatic stress disorder (PTSD). However, little is known about IPV and its association with mental health among TGD young adults. This is noteworthy, as this is a key developmental period for many TGD individuals. Methods: Thus, the present study sought (1) to estimate the lifetime and past-year prevalence of several forms of general and identity-specific IPV among a sample of (N = 200) TGD young adults in New York City and (2) to assess the associations between IPV with recent symptoms of depression, anxiety, and PTSD. To address the study aims, a cross-sectional quantitative survey was conducted between July 2019 and March 2020. Results: Regarding lifetime IPV, IA was most prevalent (57.0%), followed by sexual (40.0%), physical (38.5%), T-IPV (35.5%), and psychological IPV (32.5%). Regarding past-year IPV, psychological IPV was most common (29.0%), followed by IA (27.5%), physical (20.0%), T-IPV (14.0%), and sexual IPV (12.5%). Results of hierarchical regression models indicate that lifetime IA was related to depression, anxiety, and PTSD, while past-year T-IPV was only associated with depression. Conclusions: Taken together, these findings suggest that IPV is highly prevalent among TGD young adults and that IPV - especially identity-specific forms - warrants additional attention from researchers, healthcare professionals, and policymakers, as it may place this population at risk for negative mental health outcomes.

Barriers and facilitators related to COVID-19 vaccine acceptance and uptake among people living with HIV.

PURPOSE OF REVIEW: This review reports on the myriad barriers and facilitators related to COVID-19 vaccine hesitancy and factors contribution to uptake among people living with HIV (PLWH) globally published over the past year (2021-2022). RECENT FINDINGS: Across the literature, participants indicated concerns about the safety, efficacy and overall rapid development of the COVID-19 vaccine as a reason for delaying or not being vaccinated. Medical mistrust and perceptions about the risk of COVID-19 immune response and severity also played a role in COVID-19 vaccine hesitancy among PLWH. Almost every study examined different sociodemographic characteristics associated with COVID-19 vaccination acceptance and uptake, and although strong themes emerged around race/ethnicity, sex and educational attainment, the results were mixed across other characteristics, including age. Some studies also examined medical factors specifically related to PLWH including CD4 + cell count and adherence to antiretroviral therapy. SUMMARY: The findings highlight individual, structural and social differences in COVID-19 vaccine acceptance and uptake among PLWH, which are varied throughout the world. We call on researchers and interventionists to not just consider the role of medical mistrust and disinformation, but also how emotional, financial and political vulnerability plays into making decisions around COVID-19 vaccine uptake and overall healthcare.

Assessing the Factor Structure and Psychometric Properties of the HIV-Related Resilience Screener: The GOLD Studies.

People who are 50 and older constitute the majority of those living with HIV/AIDS (PLWHA) in the US. Aging PLWHA face myriad biopsychosocial health challenges related to HIV/AIDS and the aging process. Resilience may act as a buffer to the negative impact of these challenges however measuring it among PLWHA has been inconsistent, so the HIV-Related Resilience Screener (HIV-RRS) was developed. Data for the present study are drawn from 250 sociodemographically diverse HIV-positive gay men ages 50-69 in NYC. Tests of reliability and validity were conducted, and an Exploratory Factor Analysis indicated a three-factor model was the most parsimonious solution. Items were examined for their underlying relationships and labeled: adaptive coping, optimism, and effective coping. The total HIV-RRS yielded a Cronbach's α of 0.84. Convergent and face validity were established using psychosocial and physical outcomes. The HIV-RRS is a psychometrically sound instrument to assess resilience among older HIV-positive gay men.

An Exploration of Racial Differences of Psychosocial Stressors and Their Association With Mental Health Between Asian and White Sexual Minority Men: The P18 Cohort Study.

There is growing concern that Asian sexual minority men (SMM), including gay, bisexual, and other men who have sex with men, may be at elevated risk of psychological distress and suicidal ideation, yet limited attention has focused on how psychosocial stressors may affect them. This study seeks to (a) explore differences in psychosocial stressors, anxiety, depression, and suicidal ideation between Asian and White SMM and (b) evaluate the potential moderation of associations between psychosocial stressors and mental health by race. Data were obtained from the P18 Cohort Study. We restricted the sample to only those who identified as non-Hispanic Asian or White and used regression analysis to assess the associations of psychosocial stressors and mental health outcomes in the overall sample by race. Of the 217 participants in our analytic sample, 23% self-identified as Asian. Compared with White SMM, Asian SMM had a higher prevalence of loneliness, internalized homophobia, and public gay-related stigma. In regression analyses, most psychosocial stressors were significantly associated with anxiety, depression, and suicidal ideation in the overall sample. Associations between each stressor and mental health outcome primarily did not differ between Asian and White SMM. However, White SMM experiencing higher levels of public gay-related stigma had greater odds of suicidal ideation, although this was not observed for Asian SMM. Overall, Asian SMM may be experiencing similar effects of psychosocial stressors on mental health to White SMM. Health professionals may want to consider how these stressors impact the mental health and well-being of their Asian SMM clients.

Biological, Behavioral, and Demographic Drivers of Recent Syphilis Infection Among Emerging Adult Sexual Minority Men in New York City: The P18 Cohort Study.

The rate of syphilis infections among sexual minority men (SMM) has continued to increase in recent decades. As such, this analysis sought to identify demographic, biological, and behavioral factors associated with recent syphilis infection in emerging adult SMM. Data were drawn from a 3-year cohort study of emerging adult SMM (n = 665), from July 2014 to March 2019. Biannual study assessments included rapid HIV testing and behavioral surveys. At baseline, and at the 18- and 36-month time points, participants underwent chlamydia, gonorrhea, and syphilis screening. Generalized estimating equations were used to generate four models of repeated syphilis screening. In this racially/ethnically and socioeconomically diverse sample of SMM, 5.0% of participants tested positive for syphilis at baseline and 9.0% had an infection at the subsequent time points. Across all models, racial/ethnic minority SMM had higher odds of syphilis. Higher odds of syphilis infection were also significantly associated with more frequent condomless anal sex, more frequent marijuana use, HIV seropositivity, not currently using pre-exposure prophylaxis (PrEP), and not receiving syphilis testing in the previous 6 months; lower odds were associated with more frequent oral sex and more frequent alcohol use. These findings support current screening guidelines based on SMM who may be at increased risk for sexually transmitted infection (STI) acquisition, such as people living with HIV or those who engage in condomless sex. Further, our findings of reduced syphilis incidence among those who are on PrEP and engaged in regular STI testing support existing efforts to increase the availability and accessibility of preventive sexual health care for SMM.

Predictors of Anal High-Risk HPV Infection Across Time in a Cohort of Young Adult Sexual Minority Men and Transgender Women in New York City, 2015-2020.

Cisgender sexual minority men (SMM) and transgender women are disproportionately vulnerable to HPV-related anal cancer, but little is known about longitudinal predictors of high-risk human papillomavirus (hrHPV) infection in this population. As such, this analysis aims to identify factors associated with incident anal hrHPV infection in a diverse cohort of young SMM and transgender women. This study of HPV infection, nested within a larger cohort study, took place between October 2015 and January 2020. Participants completed a brief computer survey assessing HPV symptomatology, risk, and prevention alongside multi-site testing, in addition to biannual cohort study assessments. In the analytic sample of 137 participants, 31.6% tested positive for an anal hrHPV infection, with 27.0% and 29.9% testing positive for incident anal hrHPV infections at Visits 2 and 3, respectively. When adjusting for time between study visits, participants had significantly greater odds of incident anal hrHPV at Visit 2 if they had a concurrent HSV infection (AOR = 5.08 [1.43, 18.00]). At Visit 3, participants had significantly greater odds of incident anal hrHPV infection if they reported a greater number of sex partners in the previous month (AOR = 1.25 [1.03, 1.51]). Prevalence of cancer-causing HPV at baseline was high and many participants tested positive for additional types of anal hrHPV at subsequent visits. Risk for newly detected anal hrHPV infection was significantly associated with biological and behavioral factors. Our findings strongly indicate a need for programs to increase uptake of HPV vaccination and provide HPV-related health education for sexual and gender minorities.

Sex in the Time of COVID-19: Patterns of Sexual Behavior Among LGBTQ+ Individuals in the U.S.

The SARS-CoV-2 virus, the pathogen which causes COVID-19, has left an indelible impact on the daily lives of individuals in the USA. This study sought to explore the sexual behaviors among people in the LGBTQ+ population at the onset of the pandemic. Behaviors were explored across sub-groups of the population. The study employed data from an internet survey about the impact of COVID-19 on LGBTQ+ identified individuals conducted between May and July 2020. The final sample was comprised of 1090 participants from across the USA. Overall, sexual activity and the number of sexual partners decreased after March 13, 2020 (as compared to before this date) across all sexual orientation groups; however, living situation and partnership status supported sexual activity. Gay and bisexual men living with a partner or a spouse (AOR = 2.20, p = .023) and those living with a non-romantic roommate or friend (AOR = 2.88, p = .004) reported more sexual activity. For both cisgender lesbian and bisexual women and transgender and non-binary individuals, those who were married or in a domestic partnership (AOR = 4.54, p < .001; AOR = 9.97, p < .001, respectively) and those in a committed relationship (AOR = 3.54, p = .001; AOR = 8.46, p < .001, respectively) reported more sexual activity. Additionally, cisgender lesbian and bisexual women living with their partner or spouse (AOR = 2.14, p = .044) reported more sexual activity. When examining the number of sexual partners, cisgender lesbian and bisexual women and transgender and non-binary individuals in a committed relationship (AOR = 0.31, p < 0.001; AOR = 0.26, p = .004, respectively) and those living with a partner or spouse (AOR = 0.30, p = .002; AOR = 0.25, p = .028, respectively) were less likely to report two or more sexual partners. Examining the changes in sexual activity and number of sexual partners helps us better identify the effects of COVID-19 on intimate relationships and sexual behaviors. Furthermore, this study may help develop clinical best practices to facilitate risk-reduction strategies for LGBTQ+ populations when engaging in sexual activity within a communicable disease framework. Current guidance on sexual activity within a pandemic has created a unique opportunity for sex-positive public health messaging that protects individual health while also offering a framework for conversations about risk mitigation that is applicable for both COVID-19 and STI/HIV prevention.

Post-Exposure Prophylaxis and Methamphetamine Use among Young Sexual Minority Men: The P18 Cohort Study.

Methamphetamine use is associated with increased risk of HIV infection among young sexual minority men (SMM). Post-exposure prophylaxis (PEP) is an effective strategy for individuals who are exposed to HIV, but there is limited research about PEP use among young SMM and its relationship with methamphetamine use. This study analyzes the association between ever PEP use and recent methamphetamine use among young SMM in New York City, using cross-sectional data from the P18 Cohort Study (n = 429). Multivariable logistic regression models were used to assess the association between methamphetamine use and ever PEP use. Compared with those who had not used methamphetamine in the last 6 months, young SMM who did use methamphetamine were significantly more likely to have ever used PEP (AOR = 6.07, 95% CI: 2.10-16.86). Young SMM who had ever used PrEP had 16 times higher odds of ever using PEP (AOR = 16, 95% CI: 7.41-35.95). Those who completed bachelor's degrees were 61% less likely to have ever used PEP (AOR = 0.39, 95% CI: 0.17-0.88). These data suggest that methamphetamine use could increase the risk of HIV infection, highlighting the critical need to target interventions for young SMM who use methamphetamine and are more likely to engage in unprotected intercourse.

Ensuring survey research data integrity in the era of internet bots.

We used an internet-based survey platform to conduct a cross-sectional survey regarding the impact of COVID-19 on the LGBTQ + population in the United States. While this method of data collection was quick and inexpensive, the data collected required extensive cleaning due to the infiltration of bots. Based on this experience, we provide recommendations for ensuring data integrity. Recruitment conducted between May 7 and 8, 2020 resulted in an initial sample of 1251 responses. The Qualtrics survey was disseminated via social media and professional association listservs. After noticing data discrepancies, research staff developed a rigorous data cleaning protocol. A second wave of recruitment was conducted on June 11-12, 2020 using the original recruitment methods. The five-step data cleaning protocol led to the removal of 773 (61.8%) surveys from the initial dataset, resulting in a sample of 478 participants in the first wave of data collection. The protocol led to the removal of 46 (31.9%) surveys from the second two-day wave of data collection, resulting in a sample of 98 participants in the second wave of data collection. After verifying the two-day pilot process was effective at screening for bots, the survey was reopened for a third wave of data collection resulting in a total of 709 responses, which were identified as an additional 514 (72.5%) valid participants and led to the removal of an additional 194 (27.4%) possible bots. The final analytic sample consists of 1090 participants. Although a useful and efficient research tool, especially among hard-to-reach populations, internet-based research is vulnerable to bots and mischievous responders, despite survey platforms' built-in protections. Beyond the depletion of research funds, bot infiltration threatens data integrity and may disproportionately harm research with marginalized populations. Based on our experience, we recommend the use of strategies such as qualitative questions, duplicate demographic questions, and incentive raffles to reduce likelihood of mischievous respondents. These protections can be undertaken to ensure data integrity and facilitate research on vulnerable populations.

Prevalence and Correlates of SARS CoV-2 Among a Community-Based Sample Recruited Using Randomized Venue-Based Sampling. Essex County, NJ, 2020.

Disparities in morbidity and mortality related to COVID-19 based on race and ethnicity have been documented in the USA. However, it is unclear if these disparities also exist at the exposure stage. To determine this, studies are needed to document the underlying burden of disease, potential disparities through serologic surveillance. Additionally, such studies can help identify where along the disease spectrum (e.g., exposure, infection, diagnosis, treatment, death) and with regard to the structural factors that necessitate public health and/or clinical interventions. Our objectives in this study were to estimate the true burden of SARS CoV-2 in the community of Essex County, NJ, an early and hard hit area, to determine the correlates of SARS CoV-2 prevalence and to determine if COVID-19 disparities seen by race/ethnicity were also reflected in SARS CoV-2 burden. We utilized venue-based-sampling (VBS) to sample members of the community in Essex County. Participants completed a short electronic survey and provided finger stick blood samples for testing. We sampled 924 residents of Essex County, New Jersey. Testing conducted in this study identified 83 (9.0%) participants as positive for SARS-CoV-2 antibodies. Importantly, our findings suggest that the true burden of SARS-Cov-2 and the pool of persons potentially spreading the virus are slightly more than six times than that suggested by PCR testing Notably, there were no significant differences in odds of testing positive for SARS CoV-2 antibodies in terms of race/ethnicity where we compared Black and Latinx participants to other race participants. Our study suggests that disparities in COVID-19 outcomes stem from potential upstream issues such as underlying conditions, access to testing, and access to care rather than disparities in exposure to the virus.

Employment Loss as a Result of COVID-19: a Nationwide Survey at the Onset of COVID-19 in US LGBTQ+ Populations.

Introduction: The unemployment rate in the US reached record highs during the COVID-19 pandemic, but little is known about the job loss experiences of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals, who are already economically disadvantaged due to structural and social inequities. Methods: Cross-sectional data on unemployment due to COVID-19 were collected between May and July 2020 among 1090 individuals across the US through an online survey. Results: Respondents who had been employed prior to COVID-19 formed the analytic sample (n = 990). Of these, 298 (27.3%) reported job loss or being furloughed due to COVID-19. When controlling for all other factors, we found statistically significant higher rates of unemployment among younger participants, HIV-positive individuals, men, Black and White non-Hispanic participants, those with less educational attainment, and those in multi-person homes. Conclusions: The employment of LGBTQ+ people has been undermined by COVID-19, but as with all populations, those with multiple minority identities, such as Black or HIV+ and LGBTQ+, have been most severely affected. Policy Implications: LGBTQ+ populations in the US have experienced high levels of unemployment due to COVID-19. This study highlights the need for national data collection on sexual orientation and gender identity for unemployment as well as the need for substantive policies, such as expanding unemployment to assist in the economic recovery for populations most affected by COVID-19 and the Equality Act to offer further workplace protections.

SARS-CoV-2 Vaccination Hesitancy and Behaviors in a National Sample of People Living with HIV.

As COVID-19 vaccinations became available in early 2021, we collected data from a US national sample of 496 people living with HIV (PLWH) to assess COVID-19 vaccination uptake and attitudes. The study was cross-sectional, and data were collected using an online survey between March and May 2021. At the time, 64% of the participants received at least one dose of a COVID-19 vaccine. Vaccine uptake was associated with older age and more years living with HIV, higher educational attainment, less vaccine hesitancy, and higher perceived COVID-19 vulnerability. Rates of vaccination uptake were highest among sexual and gender minority (SGM) cisgender men and transgender participants as well as those more likely to report undetectable viral load. Among the 166 unvaccinated, intention to receive the vaccine was related to older age and years living with HIV as well as lower vaccine hesitancy. Among the unvaccinated, SGM individuals demonstrated higher intent than non-SGM individuals. Findings indicate relatively high levels of vaccination in PLWH, although uptake and intent are not monolithic in the population. Patterns of vaccination are consistent with the health behavior literature in so much as those with higher levels of perceived heath vulnerability due to age as well as higher levels of proactivity about their HIV health are more likely to be vaccinated or intend to be vaccinated. Ongoing vigilance is required to vaccinate the US population, particularly those with underlying conditions such as HIV, as is the need to tailor health messaging to the highly diverse population of PLWH, with particular emphasis on the intersection of HIV and SGM status.

Racial and ethnic disparities in "stop-and-frisk" experience among young sexual minority men in New York City.

Although racial/ethnic disparities in police contact are well documented, less is known about other dimensions of inequity in policing. Sexual minority groups may face disproportionate police contact. We used data from the P18 Cohort Study (Version 2), a study conducted to measure determinants of inequity in STI/HIV risk among young sexual minority men (YSMM) in New York City, to measure across-time trends, racial/ethnic disparities, and correlates of self-reported stop-and-frisk experience over the cohort follow-up (2014-2019). Over the study period, 43% reported stop-and-frisk with higher levels reported among Black (47%) and Hispanic/Latinx (45%) than White (38%) participants. Stop-and-frisk levels declined over follow-up for each racial/ethnic group. The per capita rates among P18 participants calculated based on self-reported stop-and-frisk were much higher than rates calculated based on New York City Police Department official counts. We stratified respondents' ZIP codes of residence into tertiles of per capita stop rates and observed pronounced disparities in Black versus White stop-and-frisk rates, particularly in neighborhoods with low or moderate levels of stop-and-frisk activity. YSMM facing the greatest economic vulnerability and mental disorder symptoms were most likely to report stop-and-frisk. Among White respondents levels of past year stop-and-frisk were markedly higher among those who reported past 30 day marijuana use (41%) versus those reporting no use (17%) while among Black and Hispanic/Latinx respondents stop-and-frisk levels were comparable among those reporting marijuana use (38%) versus those reporting no use (31%). These findings suggest inequity in policing is observed not only among racial/ethnic but also sexual minority groups and that racial/ethnic YSMM, who are at the intersection of multiple minority statuses, face disproportionate risk. Because the most socially vulnerable experience disproportionate stop-and-frisk risk, we need to reach YSMM with community resources to promote health and wellbeing as an alternative to targeting this group with stressful and stigmatizing police exposure.

A Nationwide Survey of COVID-19 Testing in LGBTQ+ Populations in the United States.

OBJECTIVES: Lesbian, gay, bisexual, transgender, or queer and questioning (LGBTQ+) people and populations face myriad health disparities that are likely to be evident during the COVID-19 pandemic. The objectives of our study were to describe patterns of COVID-19 testing among LGBTQ+ people and to differentiate rates of COVID-19 testing and test results by sociodemographic characteristics. METHODS: Participants residing in the United States and US territories (N = 1090) aged ≥18 completed an internet-based survey from May through July 2020 that assessed COVID-19 testing and test results and sociodemographic characteristics, including sexual orientation and gender identity (SOGI). We analyzed data on receipt and results of polymerase chain reaction (PCR) and antibody testing for SARS-CoV-2 and symptoms of COVID-19 in relation to sociodemographic characteristics. RESULTS: Of the 1090 participants, 182 (16.7%) received a PCR test; of these, 16 (8.8%) had a positive test result. Of the 124 (11.4%) who received an antibody test, 45 (36.3%) had antibodies. Rates of PCR testing were higher among participants who were non-US-born (25.4%) versus US-born (16.3%) and employed full-time or part-time (18.5%) versus unemployed (10.8%). Antibody testing rates were higher among gay cisgender men (17.2%) versus other SOGI groups, non-US-born (25.4%) versus US-born participants, employed (12.6%) versus unemployed participants, and participants residing in the Northeast (20.0%) versus other regions. Among SOGI groups with sufficient cell sizes (n > 10), positive PCR results were highest among cisgender gay men (16.1%). CONCLUSIONS: The differential patterns of testing and positivity, particularly among gay men in our sample, confirm the need to create COVID-19 public health messaging and programming that attend to the LGBTQ+ population.

Event-level patterns of methamphetamine and poly-drug use among millennial sexual minority men: The P18 Cohort Study.

INTRODUCTION: Knowledge on methamphetamine use among a new generation of sexual minority men (SMM) is limited. This study describes the event-level patterns of methamphetamine use and characteristics of methamphetamine users across time among Millennial SMM emerging into adulthood. METHODS: A prospective cohort study was conducted in two waves: 2009-2014 (Wave I) and 2014-2019 (Wave II) in the New York City metropolitan area. A total of 600 Millennial SMM ages 18-19 years were recruited for Wave I. A total of 665 SMM ages 22-23 years were recruited for Wave II, of which 41.2% (n = 274) were retained from Wave I. The Timeline Followback assessment was conducted every six months to record event-level drug use in the 30 days prior to the visit. RESULTS: A total of 5.4% of participants of between the ages of 18-27 reported methamphetamine use throughout the study period. The average number of days of methamphetamine use was significantly higher among racial/ethnic minority men in Wave II (F = 4.34, p = 0.0029). We found methamphetamine use occurred more often on weekend days and same-day use of methamphetamine occurred most often with cannabis and gamma-hydroxybutyrate. Usage of methamphetamine was significantly greater among SMM in Wave II who by design were older than Wave I. CONCLUSION: We have identified differences in methamphetamine use by race/ethnicity. Weekend use and poly-drug use were common among methamphetamine-using SMM. Data indicate differential use in the population and that attempts to address this addictive behavior must be linked to other drug use and socialization among young SMM.

Age of Sexual Debut among Young Gay-identified Sexual Minority Men: The P18 Cohort Study.

Age of sexual debut is a critical health indicator for young sexual minority men (YSMM), associated with an increased likelihood of HIV acquisition, use of alcohol, tobacco, and other substances, and psychological distress. This study examined the age of same-sex sexual debut for five sexual behaviors in a sample of racially/ethnically and socioeconomically diverse gay-identified YSMM in New York City. The mean age of sexual debut of any behavior was 14.5 years old and 19% of the sample reported sexual debut prior to age 13. Overall, mutual masturbation occurred at the youngest mean age, followed by performed oral, received oral, receptive anal, and insertive anal intercourse. There were significant differences by race/ethnicity and perceived familial socioeconomic status (SES), such that Black and Hispanic/Latino men had earlier ages of debut for performed oral and receptive and insertive anal sex, while upper SES men had later ages of debut for receptive and insertive anal intercourse. These findings are relevant to trends in HIV incidence in the U.S., which are highest among Black and Hispanic/Latino YSMM and may be associated with earlier age of sexual debut. These findings also underscore a need for comprehensive and inclusive sex education at younger ages.