A qualitative assessment of barriers to healthcare and HIV prevention services among men who have sex with men in non-metropolitan areas of the south.

HIV cases are increasing in the rural Southern United States, especially among men who have sex with men (MSM). To facilitate healthcare access and encourage HIV prevention for non-metropolitan MSM, it is essential to examine their barriers to care. This qualitative study conducted semi-structured interviews with 20 MSM living in non-metropolitan areas of the South. Analysis revealed that MSM experience multiple barriers accessing healthcare in non-metropolitan areas such as finding knowledgeable and affirming providers with desired characteristics and beliefs and communicating with providers about sexual health and HIV prevention. To aid in identification, many respondents expressed a desire for providers to publicly signal that they provide care for sexual and gender minority patients and are an inclusive clinical space. Overall, results suggest that MSM face unique healthcare-related challenges, beyond those typically experienced by the broader population in non-metropolitan areas, because of tailored identity-based needs. To better support MSM in non-metropolitan areas, especially in the South where increased experiences of stigma are found, providers should seek further training regarding sexual health communication and HIV prevention, indicate on websites and in offices that they support sexual and gender minority patients, and provide telehealth services to MSM living in more geographically isolated areas.

The mediating role of social support between HIV stigma and sexual orientation-based medical mistrust among newly HIV-diagnosed gay, bisexual, and other men who have sex with men.

HIV-related stigma and medical mistrust are significant challenges to addressing HIV inequities among gay, bisexual, and other men who have sex with men (MSM). HIV-related stigma is associated with high levels of medical mistrust, but there is limited knowledge regarding the mechanisms that link these variables. We examined the potential mediating roles of social support and coping in the relationship between perceived HIV stigma and sexual orientation based-medical mistrust among newly HIV-diagnosed MSM. We hypothesized that HIV-related stigma would be associated with mistrust and that social support, and coping would mediate this relationship. Data were obtained from 202 newly HIV-diagnosed (<1 year) MSM receiving care at community HIV clinics in New York. A path model indicated that HIV stigma was directly related to greater sexual orientation based medical mistrust, and that this relationship was mediated by social support. However, coping did not mediate the relationship between HIV stigma and mistrust. Efforts to increase social support and decrease stigma are critical for strengthening relationships between MSM and HIV care networks. Future research should assess the feasibility of designing and implementing interventions focused on increasing social network support and improving trust in the medical community among newly HIV-diagnosed MSM.

The Discrimination Experiences and Coping Responses of Non-binary and Trans People.

Trans and non-binary (TNB) people face mental health disparities, likely due to discrimination. This study aims to explore the types of discrimination that TNB people report and the corresponding coping strategies. A sample of 85 TNB adults between the ages of 18 and 46 years old completed two surveys a day for 30 days reporting discrimination, coping, and emotional state. The types of discriminatory events were grouped into four categories: rejection, active transphobia, microaggressions, and community-level transphobia. A total of 3240 discriminatory events were reported, with the most frequent types reported being misgendering and other microaggressions. Results from linear regressions found individuals who experienced rejection were less likely to use support-based coping strategies, while individuals who experienced multiple events were more likely to report marijuana use. These findings should encourage researchers and practitioners to pay attention to discrimination when intervening on mental health with people who identify as TNB.

Dating app use among rural men who have sex with men and its relationship to HIV prevention and risk behaviors: a mixed-methods analysis.

INTRODUCTION: Men who have sex with men (MSM) in rural areas have limited access to HIV prevention and education resources. Given the growing usage of mobile dating apps among the wider MSM population, this research sought to explore their use among MSM in rural areas and their potential for delivering HIV prevention information. METHODS: Participants were recruited from different areas of the rural Southern USA. This mixed-methods study consisted of an online survey (n=85) and follow-up qualitative phone interviews with 20 survey respondents. The survey assessed dating app use, sexual behaviors, and pre-exposure prophylaxis (PrEP) awareness, usage, and attitudes among MSM in the rural, Southern USA. Interviews explored perceptions of dating apps and their potential value as a source of health and HIV prevention information. RESULTS: Among survey respondents, 74% had used a dating app, with Grindr being the most frequently used app. Of individuals who were in a relationship, 41% had met their current partner online. Using a dating app was associated with having a greater number of sexual partners. Three-quarters of participants had heard of PrEP, but only 7% had ever received a prescription for it and less than one-third reported that it would be easy to get PrEP if they wanted it. Dating app users were more likely than non-app users to have more positive attitudes toward taking PrEP and interest in taking PrEP. In qualitative interviews, respondents expressed support for integrating HIV prevention information into dating apps. CONCLUSION: Dating app usage is high among rural MSM. Individuals who use these apps have more sexual partners and also are more interested in PrEP for HIV prevention, suggesting that this is an ideal group to target for PrEP education and interventions. This could be especially beneficial for MSM in rural areas, as most have difficulty accessing PrEP and PrEP education.

Low and Increasing Trajectories of Perpetration of Physical Dating Violence: 7-Year Associations with Suicidal Ideation, Weapons, and Substance Use.

Understanding the interrelation among problem behaviors and their change over time is fundamental for prevention research. The Healthy Teens Longitudinal Study followed a cohort of adolescents from Grades 6-12. Prior research identified two distinct trajectories of perpetration of physical dating violence: Low and Increasing. The purpose of this study was to examine whether adolescents in these two trajectories differed longitudinally on other problem behaviors: (1) suicidal ideation and attempts, (2) weapon-carrying and threats with a weapon, and (3) substance use, particularly alcohol and marijuana. The sample consisted of 588 randomly-selected students (52% males; 49% White, 36% Black, 12% Latino). Students completed a self-reported, computer-based survey each spring from Grades 6-12. To examine significant differences by perpetration of physical dating violence trajectory, we used Chi-square test and generalized estimating equations modeling. Across most grades, significantly more students in Increasing than in the Low trajectory reported suicidal ideation and attempts, carried a weapon, and threatened someone with a weapon. Adolescents in the Increasing trajectory also had higher trajectories of alcohol use, being drunk, and marijuana use than those in the Low trajectory. All differences were already significant in Grade 6. The difference in the rate of change between groups was not significant. This longitudinal study highlights that problem behaviors-physical dating violence, suicidal ideation and attempts, weapon carrying and threats, marijuana and alcohol use-cluster together as early as sixth grade and the clustering persists over time. The combination of these behaviors poses a great public health concern and highlight the need for early interventions.