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1.
Arch Sex Behav ; 50(8): 3621-3636, 2021 11.
Article in English | MEDLINE | ID: mdl-34725750

ABSTRACT

Men who have sex with men (MSM) experience high prevalence of sexual violence (SV), and SV has well-documented effects on health. Research gaps are especially evident for young Black MSM (YBMSM), who experience significant HIV disparities and syndemics, including multiple forms of violence victimization. We examined lifetime prevalence of SV (having been forced or frightened into sexual activity) in a cross-sectional sample of YBMSM (N = 1732), and tested associations of demographic, psychosocial, and structural factors using multivariable regression. YBMSM were recruited between 2013 and 2015 using modified venue-based time-location sampling (e.g., at bars and clubs) in Dallas and Houston, Texas. Approximately 17% of YBMSM experienced any SV in their lifetimes. SV was associated with high school non-completion (OR 1.78; 95% CI 1.15-2.77), lower psychological resilience (OR 0.84; 95% CI 0.71-0.98), lifetime history of homelessness (OR 5.52; 95% CI 3.80-8.02), recent financial hardship (OR 2.16; 95% CI 1.48-3.14), and recent transactional sex (OR 3.87; 95% CI 2.43-6.15). We also examined differences by age of SV onset (childhood versus adulthood). YBMSM with adolescent/emerging adult-onset SV may have been more ambivalent in reporting lifetime SV experience, compared to men with childhood-onset SV, and correlates differed by age of onset. Childhood-onset SV was associated with high school non-completion, lower levels of psychological resilience, history of homelessness, recent financial hardship, and recent transactional sex. Adolescent/emerging adult-onset SV was associated with greater depressive symptoms, history of homelessness, and recent financial hardship. There is a need for multi-level approaches to SV prevention and treatment, including services and supports that are culturally-relevant and responsive to the needs of YBMSM.


Subject(s)
HIV Infections , Sex Offenses , Sexual and Gender Minorities , Adolescent , Adult , Child , Cross-Sectional Studies , Homosexuality, Male , Humans , Male , Prevalence , Sexual Behavior , Young Adult
2.
Stigma Health ; 5(3): 364-374, 2020 Aug.
Article in English | MEDLINE | ID: mdl-35505775

ABSTRACT

Although the health of young Black men who have sex with men (YBMSM) is typically discussed in terms of HIV, they are significantly affected by depression. The present study explored protective and risk pathways to depressive symptoms among YBMSM within a social-ecological framework. A cross-sectional sample of 1,817 YBMSM in two large, southern cities in the United States completed a survey of sociodemographic characteristics as well as individual (e.g., resilience, internalized heterosexism) and contextual (e.g., peer social support, experiences of racism) factors. In cross-sectional analyses, structural equation modeling was used to examine whether there were indirect associations between contextual factors and depressive symptomology that were mediated by individual factors. Higher peer social support was associated with lower depressive symptoms via greater resilience; there was no direct association between peer social support and depressive symptoms when controlling for this indirect association. Additionally, there were indirect associations between several contextual risk factors and higher depressive symptoms via perceived HIV-related stigma and internalized heterosexism; some direct associations between contextual risk factors and higher depressive symptoms were significant when controlling for these indirect associations. Despite a number of risk factors for depression for YBMSM, resilience is a key protective factor that may play a critical role in the beneficial effects of peer social support. Broadly, findings suggest that public health efforts must continue to build upon and leverage YBMSM's community-based strengths in the service of improving their mental health and, indirectly, their physical health.

3.
AIDS Behav ; 23(10): 2803-2815, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31407211

ABSTRACT

Although young Black men who have sex with men (YBMSM) are disproportionately affected by HIV, they may be more heterogeneous as a group than is typically appreciated. Thus, the present study used a person-centered data-analytic approach to determine profiles of HIV-related risk among YBMSM and whether these profiles could be distinguished by age, HIV status, and socioeconomic risk (i.e., socioeconomic distress). YBMSM (N = 1808) aged 18 to 29 years completed a survey of sociodemographic characteristics, HIV status, and HIV-related behavioral and attitudinal factors (i.e., safer-sex self-efficacy, negative condom attitudes, being in difficult sexual situations, being in difficult sexual relationships, HIV treatment optimism, perceived HIV stigma). Latent profile analysis was used to identify HIV risk profiles and whether age, HIV status, and socioeconomic distress were associated with these profiles. Four profiles emerged: low-, medium-, and high-risk profiles, respectively, and a mixed profile characterized by a tendency to be in difficult sexual situations and relationships while also reporting high safer-sex self-efficacy and low negative attitudes toward condom use. Difficult sexual situations emerged as the key defining indicator of whether a profile reflected higher or lower risk. Younger age, being HIV-positive, and socioeconomic distress were associated with having a higher-risk profile. Given that unique risk profiles emerged that were differentially predicted by sociodemographic characteristics and HIV status, these findings have implications for tailoring interventions to the needs of different subgroups of YBMSM. Also, disempowering or risky sexual situations and relationships among YBMSM must be addressed.


Subject(s)
Black or African American/ethnology , HIV Infections/drug therapy , HIV Infections/prevention & control , Homosexuality, Male/ethnology , Patient-Centered Care , Pre-Exposure Prophylaxis , Self Efficacy , Sexual Behavior/statistics & numerical data , Social Stigma , Adolescent , Adult , Black or African American/psychology , Condoms/statistics & numerical data , HIV Infections/epidemiology , HIV Infections/psychology , Homosexuality, Male/psychology , Humans , Male , Risk Factors , Safe Sex , Surveys and Questionnaires , Texas , Young Adult
4.
AIDS Behav ; 23(9): 2361-2374, 2019 Sep.
Article in English | MEDLINE | ID: mdl-31016504

ABSTRACT

In contrast to intervention studies that assess psychosocial factors only as mediators or moderators of HIV risk, the present study assessed the effects of an Mpowerment-based community-level intervention on psychosocial determinants (e.g., depressive symptoms, sexual stigma) of HIV risk behavior among young black MSM. Approximately 330 respondents were surveyed annually for 4 years in each of two sites. General linear models examined change across time between the intervention and comparison communities, and participation effects in the intervention site. Social diffusion (spreading information within networks) of safer sex messages (p < 0.01) and comfort with being gay (p < 0.05) increased with time in intervention versus control. Cross-sectionally, intervention participants responded more favorably (p < 0.05) on social diffusion and depressive symptoms, but less favorably (p < 0.01) on sex in difficult situations and attitudes toward condom use. Findings suggest a need to address broader health issues of MSM as well as sexual risk.


Subject(s)
Black or African American/psychology , Community Health Services/organization & administration , HIV Infections/ethnology , HIV Infections/prevention & control , Homosexuality, Male/ethnology , Homosexuality, Male/psychology , Power, Psychological , Risk Reduction Behavior , Social Stigma , Adolescent , Adult , Cross-Sectional Studies , HIV , HIV Infections/psychology , Health Promotion , Homosexuality, Male/statistics & numerical data , Humans , Male , Risk-Taking , Safe Sex , Self Efficacy , Sexual Behavior/psychology , Sexual and Gender Minorities , Young Adult
5.
J Consult Clin Psychol ; 85(12): 1122-1130, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28714706

ABSTRACT

OBJECTIVE: This study examined whether the association between social support and condom self-efficacy would be moderated by (a) internalized heterosexism among and (b) enacted heterosexism experienced by young Black men who have sex with men (YBMSM), who contend with high HIV incidence, heterosexism, and low uptake of preexposure prophylaxis. METHOD: Participants were 1,210 YBMSM (ages 18-29) who completed measures of social support, internalized and enacted heterosexism, and condom self-efficacy in 2 large cities in the southern United States as part of a community-level HIV-prevention study. RESULTS: A significant 3-way interaction between social support and both hypothesized moderators, internalized and enacted heterosexism, showed that social support was positively associated with condom self-efficacy when both internalized and enacted heterosexism were high (1 SD above the mean; b = .177, 95% confidence interval [CI: .088, .266]). However, social support was not associated with condom self-efficacy when scores were low (1 SD below the mean) on both internalized and enacted heterosexism (b = .024, 95% CI [-.054, .101]), low on internalized and high on enacted heterosexism (b = .058, 95% CI [-.061, .117]), or high on internalized and low on enacted heterosexism (b = .039, 95% CI [-.083, .161]). CONCLUSIONS: YBMSM who are high in both internalized and enacted heterosexism may see greater benefits from social support on condom self-efficacy than would YBMSM who grapple with less heterosexism. In addition to promoting social support, interventions should aim to assess and reduce multiple forms of stigma. (PsycINFO Database Record


Subject(s)
HIV Infections/prevention & control , Homophobia/psychology , Homosexuality, Male/psychology , Self Efficacy , Adult , Black or African American/psychology , Condoms/statistics & numerical data , Humans , Male , Social Support , United States , Young Adult
6.
Int J STD AIDS ; 28(9): 849-857, 2017 08.
Article in English | MEDLINE | ID: mdl-28632468

ABSTRACT

PrEP willingness may be different among black and white men who have sex with men (MSM) given known disparities in HIV incidence, sociodemographic factors, and healthcare access between these groups. We surveyed 482 black and white HIV-negative MSM in Atlanta, GA about their willingness to use pre-exposure prophylaxis (PrEP) and facilitators and barriers to PrEP willingness. Overall, 45% (215/482) of men indicated interest in using PrEP. Engaging in recent unprotected anal intercourse (UAI) was the only factor significantly associated with PrEP willingness in multivariate analyses (OR 1.73, 95% CI 1.13, 2.65). Willing men identified "extra protection" against HIV as the most common reason for interest in using PrEP, whereas unwilling men most commonly cited not wanting to take medication daily, and this reason was more common among white MSM (42.3% of white MSM vs. 28.9% of black MSM, p = 0.04). Most men indicated willingness to use PrEP if cost was <50 dollars/month; however, more black MSM indicated willingness to use PrEP only if cost were free (17.9% of white MSM vs. 25.9% of black MSM, p = 0.03). Overall, these data are useful to scale up PrEP interventions targeting at-risk MSM in Atlanta and highlight the need for implementation of low cost-programs, which will be especially important for black MSM.


Subject(s)
HIV Infections/prevention & control , HIV Seronegativity , Homosexuality, Male/psychology , Patient Acceptance of Health Care/psychology , Pre-Exposure Prophylaxis/methods , Adolescent , Adult , Black or African American/psychology , Black or African American/statistics & numerical data , Georgia , HIV Infections/psychology , Humans , Incidence , Male , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data , Sexual Partners , Unsafe Sex/statistics & numerical data , White People/psychology , White People/statistics & numerical data
7.
Drug Alcohol Depend ; 174: 106-112, 2017 05 01.
Article in English | MEDLINE | ID: mdl-28319751

ABSTRACT

BACKGROUND: Spirituality and religiosity may serve as both a resource and a barrier to HIV prevention with young black men who have sex with men (YBMSM). We examined indices of spirituality/religiosity as correlates of binge drinking, stimulant use, and recent HIV testing in a sample of YBMSM. METHODS: From 2011-2013, annual venue-based surveys of sexually active YBMSM ages 18-29 were conducted in Dallas and Houston, Texas. Binge drinking and stimulant use were assessed in the past two months. Participants recently tested for HIV (i.e., within the past six months) were compared to those without recent HIV testing (i.e., never tested or tested more than six months ago). RESULTS: Among the 1565 HIV-negative or HIV-unknown YBMSM enrolled, more engagement in spiritual and religious activities was associated with greater odds of reporting stimulant use (Adjusted Odds Ratio [AOR]=1.20; 95% CI=1.04-1.40) while higher spiritual coping was associated with lower odds of reporting stimulant use (AOR=0.66; 95% CI=0.56-0.78). Binge drinking was independently associated with 29% lower odds of recent HIV testing (AOR=0.71; 95% CI=0.55-0.92), but lower odds of binge drinking did not mediate the association of engagement in spiritual and religious activities with 27% greater odds of recent HIV testing (AOR=1.27; 95% CI=1.11-1.46). CONCLUSIONS: Among YBMSM, culturally tailored approaches addressing spirituality/religiosity could support prevention of stimulant use and increase HIV testing. In particular, expanded efforts are needed to promote HIV testing in binge drinkers.


Subject(s)
Black or African American , HIV Infections/diagnosis , Homosexuality, Male , Spirituality , Substance-Related Disorders/diagnosis , Unsafe Sex , Adaptation, Psychological , Adolescent , Adult , Humans , Male , Mass Screening , Religion , Texas , Young Adult
8.
Aggress Behav ; 42(6): 542-554, 2016 11.
Article in English | MEDLINE | ID: mdl-26918697

ABSTRACT

This study examined whether self-identified race and prior contact with a gay man or lesbian moderate the association between AIDS-related stigma and aggression toward gay men and lesbians when controlling for sexual prejudice. A regional, community-recruited sample of 194 heterosexual men (50% Black, 50% White) completed measures of AIDS-related stigma, sexual prejudice, and prior contact with gay men and lesbians. Regression analyses showed that AIDS-related stigma was positively associated with aggression toward gay men and lesbians among White men who reported no prior contact, but not among White men who endorsed prior contact and Black men regardless of prior contact. Findings suggest that intergroup contact may be a key component to reducing the effects of AIDS-related stigma towards stigmatized groups. Implications for aggression theory and intervention are discussed. Aggr. Behav. 42:542-554, 2016. © 2016 Wiley Periodicals, Inc.


Subject(s)
Acquired Immunodeficiency Syndrome/psychology , Aggression/psychology , Heterosexuality/psychology , Homophobia/psychology , Homosexuality/psychology , Social Stigma , Adolescent , Adult , Humans , Male , Young Adult
9.
Ann Epidemiol ; 25(6): 445-54, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25911980

ABSTRACT

PURPOSE: To describe factors associated with racial disparities in HIV (human immunodeficiency virus) incidence among men who have sex with men (MSM) in the United States. METHODS: In a longitudinal cohort of black and white HIV-negative MSM in Atlanta, HIV incidence rates were compared by race. Incidence hazard ratios (HRs) between black and white MSM were estimated with an age-scaled Cox proportional hazards model. A change-in-estimate approach was used to understand mediating time-independent and -dependent factors that accounted for the elevated HR. RESULTS: Thirty-two incident HIV infections occurred among 260 black and 302 white MSM during 843 person-years (PY) of follow-up. HIV incidence was higher among black MSM (6.5/100 PY; 95% confidence interval [CI]: 4.2-9.7) than white MSM (1.7/100 PY; CI: 0.7-3.3) and highest among young (18-24 years) black MSM (10.9/100 PY; CI: 6.2-17.6). The unadjusted hazard of HIV infection for black MSM was 2.9 (CI: 1.3-6.4) times that of white MSM; adjustment for health insurance status and partner race explained effectively all of the racial disparity. CONCLUSIONS: Relative to white MSM in Atlanta, black MSM, particularly young black MSM, experienced higher HIV incidence that was not attributable to individual risk behaviors. In a setting where partner pool risk is a driver of disparities, it is also important to maximize care and treatment for HIV-positive MSM.


Subject(s)
Black or African American/statistics & numerical data , HIV Infections/ethnology , Health Status Disparities , Homosexuality, Male , White People/statistics & numerical data , Adolescent , Adult , Georgia/epidemiology , Humans , Incidence , Kaplan-Meier Estimate , Longitudinal Studies , Male , Proportional Hazards Models , Prospective Studies , Risk-Taking , Socioeconomic Factors , Young Adult
10.
Cultur Divers Ethnic Minor Psychol ; 21(2): 258-67, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25602467

ABSTRACT

Previous research has consistently found sexual prejudice to be a predictor of antigay aggression and has also revealed specific correlates and antecedents of sexual prejudice. However, extant literature reveals mixed findings about potential racial group differences in sexual prejudice, and few studies have examined racial differences in the correlates of sexual prejudice. The aims of this descriptive study were to determine whether there are (a) racial group differences in reports of sexual prejudice and (b) racial group differences in previously identified correlates of sexual prejudice. Participants were 195 heterosexual males, ages 18 to 30 (98 Blacks and 97 Whites), recruited from a large metropolitan city in the southeastern United States. Based on cultural differences in the influence of religion and in attitudes about male sexuality, it was hypothesized that Black participants would report higher sexual prejudice than White participants. Additionally, based on cultural differences in racial views on masculinity and in sociocultural experiences of male gender roles, it was hypothesized that Blacks would report greater endorsement of religious fundamentalism and the traditional male role norm of status than Whites. Results confirmed all of the hypothesized racial differences and revealed additional differences, including a differential effect of the traditional male role norm of status on sexual prejudice, which explains, at least in part, the racial differences found in sexual prejudice. These findings may reflect underlying cultural differences between Black and White males and may aid in the development of future efforts to reduce sexual prejudice and consequently antigay aggression toward sexual minorities.


Subject(s)
Heterosexuality/ethnology , Heterosexuality/psychology , Homosexuality, Male/ethnology , Homosexuality, Male/psychology , Prejudice/ethnology , Adult , Black or African American/psychology , Aggression/psychology , Attitude , Humans , Male , Masculinity , Minority Groups/psychology , Prejudice/psychology , Religion , Sexual Behavior/ethnology , Sexual Behavior/psychology , Social Values/ethnology , Sociological Factors , Southeastern United States , White People/psychology
12.
JMIR Res Protoc ; 3(3): e37, 2014 Jul 17.
Article in English | MEDLINE | ID: mdl-25048694

ABSTRACT

BACKGROUND: Recruiting valid samples of men who have sex with men (MSM) is a key component of the US human immunodeficiency virus (HIV) surveillance and of research studies seeking to improve HIV prevention for MSM. Social media, such as Facebook, may present an opportunity to reach broad samples of MSM, but the extent to which those samples are comparable with men recruited from venue-based, time-space sampling (VBTS) is unknown. OBJECTIVE: The objective of this study was to assess the comparability of MSM recruited via VBTS and Facebook. METHODS: HIV-negative and HIV-positive black and white MSM were recruited from June 2010 to December 2012 using VBTS and Facebook in Atlanta, GA. We compared the self-reported venue attendance, demographic characteristics, sexual and risk behaviors, history of HIV-testing, and HIV and sexually transmitted infection (STI) prevalence between Facebook- and VTBS-recruited MSM overall and by race. Multivariate logistic and negative binomial models estimated age/race adjusted ratios. The Kaplan-Meier method was used to assess 24-month retention. RESULTS: We recruited 803 MSM, of whom 110 (34/110, 30.9% black MSM, 76/110, 69.1% white MSM) were recruited via Facebook and 693 (420/693, 60.6% black MSM, 273/693, 39.4% white MSM) were recruited through VTBS. Facebook recruits had high rates of venue attendance in the previous month (26/34, 77% among black and 71/76, 93% among white MSM; between-race P=.01). MSM recruited on Facebook were generally older, with significant age differences among black MSM (P=.02), but not white MSM (P=.14). In adjusted multivariate models, VBTS-recruited MSM had fewer total partners (risk ratio [RR]=0.78, 95% CI 0.64-0.95; P=.01) and unprotected anal intercourse (UAI) partners (RR=0.54, 95% CI 0.40-0.72; P<.001) in the previous 12 months. No significant differences were observed in HIV testing or HIV/STI prevalence. Retention to the 24-month visit varied from 81% for black and 70% for white MSM recruited via Facebook, to 77% for black and 78% for white MSM recruited at venues. There was no statistically significant differences in retention between the four groups (log-rank P=.64). CONCLUSIONS: VBTS and Facebook recruitment methods yielded similar samples of MSM in terms of HIV-testing patterns, and prevalence of HIV/STI, with no differences in study retention. Most Facebook-recruited men also attended venues where VTBS recruitment was conducted. Surveillance and research studies may recruit via Facebook with little evidence of bias, relative to VBTS.

13.
J Acquir Immune Defic Syndr ; 66(5): 538-43, 2014 Aug 15.
Article in English | MEDLINE | ID: mdl-24820109

ABSTRACT

OBJECTIVES: To examine the associations of homophobia, racism, and resiliency with differences in prevalent HIV infection in black and white men who have sex with men (MSM). METHODS: The Involve[ment]t study is a cohort of black and white MSM aged 18-39 years in Atlanta, GA, designed to evaluate individual, dyadic, and community level factors that might explain racial disparities in HIV prevalence. Participants were recruited irrespective of HIV serostatus from community-based venues and from Internet advertisements and were tested for HIV. We assessed respondents' demographics, whether they had engaged in unprotected anal intercourse (UAI) within the past 6 months, and attitudes about perceived homophobia, perceived racism, and personal resiliency. RESULTS: Compared with white MSM, black MSM were less likely to report UAI in the past 6 months [odds ratio (OR): 0.59, confidence interval (CI): 0.44 to 0.80], more likely to be HIV positive (OR: 5.05, CI: 3.52 to 7.25), and--among those HIV positive--more likely to report not being aware of their HIV infection (OR: 2.58, CI: 1.18 to 5.65). Greater perceived racism was associated with UAI in the black sample (partial odds ratio: 1.48, CI: 1.10 to 1.99). Overall, perceived homophobia, perceived racism, and resilience were not associated with prevalent HIV infection in our samples. Greater resilience was associated with less perceived homophobia in both black and white samples (Spearman r = -0.27, P < 0.001, for both). CONCLUSION: Future studies of social discrimination at the institutional and network level, than at the individual level, may explain differences in HIV infection in black and white MSM.


Subject(s)
Black or African American , HIV Infections/epidemiology , Homosexuality, Male , Resilience, Psychological , Social Discrimination , White People , Adolescent , Adult , Humans , Male , Young Adult
14.
Health Psychol ; 33(12): 1568-78, 2014 Dec.
Article in English | MEDLINE | ID: mdl-24274807

ABSTRACT

OBJECTIVE: Young Black men who have sex with men (YBMSM) are at extraordinarily high risk for HIV infection. Given their dual minority identity, they experience multiple forms of social oppression-racism, homophobia, and poverty. This study tested a model for how these forces contribute to their sexual risk behavior. METHOD: YBMSM (n = 1,289) from 2 Texas cities completed a 1-time assessment of sexual behaviors and psychosocial variables. Structural equation modeling was used to characterize relationships among variables. RESULTS: Experiences of racism, homophobia, and socioeconomic distress were all associated with unprotected anal intercourse (UAI) either directly or indirectly in a manner largely consistent with Díaz's (1997, 1998) model of the effects of social oppression. Racism, homophobia, and socioeconomic distress were each associated with specific psychological vulnerabilities, which were in turn associated with participation in difficult sexual situations (e.g., in a public setting), and then UAI. The effects of racism were largely mediated by depressive symptoms and participation in difficult sexual situations. Homophobia was mediated by depressive symptoms, social support, and internalized homophobia. The effects of socioeconomic distress were partially mediated by decreased social support and greater participation in difficult sexual situations. Socioeconomic distress also had a significant direct effect on UAI not explained by the proposed mediators. CONCLUSIONS: Social oppression contributes to YBMSM's psychological vulnerabilities, participation in difficult sexual situations, and their UAI. Interventions to reduce sexual risk in YBMSM should address socioeconomic disadvantage, homophobia, and racism, as well as the psychological challenges that social oppression creates for them.


Subject(s)
Black or African American/psychology , Homophobia/ethnology , Homosexuality, Male/ethnology , Poverty/ethnology , Racism/ethnology , Unsafe Sex/ethnology , Adolescent , Adult , Black or African American/statistics & numerical data , Depression/ethnology , Depression/psychology , HIV Infections/ethnology , Homophobia/psychology , Homosexuality, Male/psychology , Homosexuality, Male/statistics & numerical data , Humans , Male , Models, Psychological , Poverty/psychology , Racism/psychology , Risk-Taking , Sexual Behavior/ethnology , Sexual Behavior/psychology , Social Support , Texas , Unsafe Sex/psychology , Young Adult
15.
Lancet ; 380(9839): 411-23, 2012 Jul 28.
Article in English | MEDLINE | ID: mdl-22819654

ABSTRACT

Pooled estimates from across the African diaspora show that black men who have sex with men (MSM) are 15 times more likely to be HIV positive compared with general populations and 8·5 times more likely compared with black populations. Disparities in the prevalence of HIV infection are greater in African and Caribbean countries that criminalise homosexual activity than in those that do not criminalise such behaviour. With the exception of US and African epidemiological studies, most studies of black MSM mainly focus on outcomes associated with HIV behavioural risk rather than on prevalence, incidence, or undiagnosed infection. Nevertheless, black MSM across the African diaspora share common experiences such as discrimination, cultural norms valuing masculinity, concerns about confidentiality during HIV testing or treatment, low access to HIV drugs, threats of violence or incarceration, and few targeted HIV prevention resources.


Subject(s)
Black People , HIV Infections/ethnology , Homosexuality, Male/ethnology , Africa/ethnology , HIV Infections/therapy , Humans , Male , Prejudice , Sexual Behavior , Social Stigma
16.
Lancet ; 380(9839): 341-8, 2012 Jul 28.
Article in English | MEDLINE | ID: mdl-22819656

ABSTRACT

BACKGROUND: We did a meta-analysis to assess factors associated with disparities in HIV infection in black men who have sex with men (MSM) in Canada, the UK, and the USA. METHODS: We searched Embase, Medline, Google Scholar, and online conference proceedings from Jan 1, 1981, to Dec 31, 2011, for racial comparative studies with quantitative outcomes associated with HIV risk or HIV infection. Key words and Medical Subject Headings (US National Library of Medicine) relevant to race were cross-referenced with citations pertinent to homosexuality in Canada, the UK, and the USA. Data were aggregated across studies for every outcome of interest to estimate overall effect sizes, which were converted into summary ORs for 106,148 black MSM relative to 581,577 other MSM. FINDINGS: We analysed seven studies from Canada, 13 from the UK, and 174 from the USA. In every country, black MSM were as likely to engage similarly in serodiscordant unprotected sex as other MSM. Black MSM in Canada and the USA were less likely than other MSM to have a history of substance use (odds ratio, OR, 0·53, 95% CI 0·38-0·75, for Canada and 0·67, 0·50-0·92, for the USA). Black MSM in the UK (1·86, 1·58-2·18) and the USA (3·00, 2·06-4·40) were more likely to be HIV positive than were other MSM, but HIV-positive black MSM in each country were less likely (22% in the UK and 60% in the USA) to initiate combination antiretroviral therapy (cART) than other HIV-positive MSM. US HIV-positive black MSM were also less likely to have health insurance, have a high CD4 count, adhere to cART, or be virally suppressed than were other US HIV-positive MSM. Notably, despite a two-fold greater odds of having any structural barrier that increases HIV risk (eg, unemployment, low income, previous incarceration, or less education) compared with other US MSM, US black MSM were more likely to report any preventive behaviour against HIV infection (1·39, 1·23-1·57). For outcomes associated with HIV infection, disparities were greatest for US black MSM versus other MSM for structural barriers, sex partner demographics (eg, age, race), and HIV care outcomes, whereas disparities were least for sexual risk outcomes. INTERPRETATION: Similar racial disparities in HIV and sexually transmitted infections and cART initiation are seen in MSM in the UK and the USA. Elimination of disparities in HIV infection in black MSM cannot be accomplished without addressing structural barriers or differences in HIV clinical care access and outcomes. FUNDING: None.


Subject(s)
Black People , HIV Infections/ethnology , Homosexuality, Male/ethnology , Sexual Behavior/statistics & numerical data , Adolescent , Adult , Canada/ethnology , HIV Infections/epidemiology , Humans , Male , Risk Factors , United Kingdom/ethnology , United States/ethnology , Young Adult
17.
AIDS Educ Prev ; 24(2): 91-101, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22468971

ABSTRACT

The association between HIV treatment optimism--beliefs about susceptibility to transmit HIV, motivation to use condoms, and severity of HIV--and sexual risk behavior was examined among HIV-positive African American men who have sex with men (MSM). Participants were 174 men recruited in four major metropolitan areas of the United States to participate in a weekend HIV risk reduction intervention. Baseline results revealed that beliefs in less susceptibility to transmit HIV and less motivation to use condoms were significantly associated with more unprotected anal intercourse among serodiscordant casual partners. Less motivation to use condoms also predicted more unprotected insertive and receptive anal sex and was more important than susceptibility beliefs in predicting these behaviors. Suggestions are offered of ways to better inform HIV-positive African American MSM about their misperceptions about HIV treatment and how their level of optimism about HIV treatment may diminish or encourage condom use.


Subject(s)
HIV Infections/ethnology , HIV Infections/psychology , Homosexuality, Male/ethnology , Homosexuality, Male/psychology , Risk-Taking , Sexual Behavior/psychology , Adult , Black or African American , Aged , Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , HIV Infections/transmission , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Sexual Behavior/ethnology , Sexual Partners , United States , Young Adult
18.
PLoS One ; 7(12): e53284, 2012.
Article in English | MEDLINE | ID: mdl-23285274

ABSTRACT

BACKGROUND: Various metrics for HIV burden and treatment success [e.g. HIV prevalence, community viral load (CVL), population viral load (PVL), percent of HIV-positive persons with undetectable viral load] have important public health limitations for understanding disparities. METHODS AND FINDINGS: Using data from an ongoing HIV incidence cohort of black and white men who have sex with men (MSM), we propose a new metric to measure the prevalence of those at risk of transmitting HIV and illustrate its value. MSM with plasma VL>400 copies/mL were defined as having 'transmission risk'. We calculated HIV prevalence, CVL, PVL, percent of HIV-positive with undetectable viral loads, and prevalence of plasma VL>400 copies/ml (%VL400) for black and white MSM. We used Monte Carlo simulation incorporating data on sexual mixing by race to estimate exposure of black and white HIV-negative MSM to a partner with transmission risk via unprotected anal intercourse (UAI). Of 709 MSM recruited, 42% (168/399) black and 14% (44/310) white MSM tested HIV-positive (p<.0001). No significant differences were seen in CVL, PVL, or percent of HIV positive with undetectable viral loads. The %VL400 was 25% (98/393) for black vs. 8% (25/310) for white MSM (p<.0001). Black MSM with 2 UAI partners were estimated to have 40% probability (95% CI: 35%, 45%) of having ≥1 UAI partner with transmission risk vs. 20% for white MSM (CI: 15%, 24%). DISCUSSION: Despite similarities in other metrics, black MSM in our cohort are three times as likely as white MSM to have HIV transmission risk. With comparable risk behaviors, HIV-negative black MSM have a substantially higher likelihood of encountering a UAI partner at risk of transmitting HIV. Our results support increasing HIV testing, linkage to care, and antiretroviral treatment of HIV-positive MSM to reduce prevalence of those with transmission risk, particularly for black MSM.


Subject(s)
HIV Infections/epidemiology , HIV Infections/etiology , HIV Infections/transmission , Homosexuality, Male , Sexual Behavior/physiology , Adolescent , Adult , Cohort Studies , HIV Infections/blood , HIV-1/physiology , Humans , Male , Population , Prevalence , Risk Factors , Viral Load , Young Adult
19.
Psychol Men Masc ; 12(4): 383-400, 2011 Oct.
Article in English | MEDLINE | ID: mdl-22081759

ABSTRACT

Sexual prejudice and antigay anger were examined as mediators of the associations between traditional male gender norms, religious fundamentalism, and aggression toward gay men and lesbians. Participants were 201 self-identified heterosexual men recruited from the community to complete computer-administered measures of adherence to traditional male gender norms (i.e., status, toughness, antifemininity), religious fundamentalism, sexual prejudice, and frequency of aggression toward gay men and lesbians. Additionally, participants completed a structured interview designed to assess anger in response to a vignette depicting a male-male intimate relationship (i.e., partners saying "I love you," holding hands, kissing). Results showed that sexual prejudice and antigay anger partially mediated the effect of antifemininity on aggression and fully mediated the effect of religious fundamentalism on aggression. Sexual prejudice alone fully mediated the effect of status on aggression and neither sexual prejudice nor antigay anger mediated the effect of toughness on aggression. Further, results suggested that religious fundamentalism is a multifaceted construct of which some aspects increase risk for aggression toward gay men and lesbians, whereas other aspects decrease this risk. These data provide multivariate evidence from a nonprobability, community-based sample that extreme internalization of dominant cultural values can set the stage for violence toward marginalized groups. Implications for intervention programming and future research are reviewed.

20.
Psychol Violence ; 1(1): 41-52, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21479161

ABSTRACT

OBJECTIVE: Sexual prejudice and masculine gender role stress were examined as mediators of the associations between adherence to different male gender norms and aggression toward sexual minorities. This study also sought to extend past research to a community sample and employ multiple methods to assess aggression. METHOD: Participants were 199 heterosexual men between the ages of 18-30 who were recruited from a large southeastern United States city. Participants completed measures of adherence to male gender role norms, sexual prejudice, masculine gender role stress, and aggression toward sexual minorities. RESULTS: Associations between adherence to the status and antifemininity norms and aggression toward sexual minorities were mediated by sexual prejudice, but not masculine gender role stress. The portion of unique association between adherence to the antifemininity norm and aggression toward sexual minorities was about three times larger than the portion mediated by sexual prejudice and masculine gender role stress. CONCLUSIONS: Findings provide the first multivariate evidence from a community-based sample for determinants of aggression toward sexual minorities motivated by gender role enforcement. These data support intervention programming and preventative intervention studies aimed at reducing sexual prejudice and facilitating less stereotypic attitudes about the male gender role, particularly surrounding the antifemininity norm.

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