"You know that we travel a lot": Mobility narratives among female sex workers living with HIV in Tanzania and the Dominican Republic.

Female sex workers (FSW) are highly mobile, which may result in reduced access to and use of health services and increased risk for poor health outcomes, particularly for those living with HIV. Mobility includes spatial, temporal, and social elements that are not fully captured by quantitative measures. We conducted two rounds of in-depth interviews with FSW living with HIV in Iringa, Tanzania (n = 20), and Santo Domingo, Dominican Republic (n = 20), to describe mobility experiences and compare mobility narratives across settings. We integrated a thematic analysis of all interviews with a narrative analysis of a subset of 10 information-rich interviews (five in each country) with women who had recently traveled, for sex work or another reason, outside of their hometown. Across narratives, FSW living with HIV traveled locally or to seasonal destinations, for short and long periods. Social factors influencing mobility included economic drivers; risk of arrest, harassment, or violence; anonymity and/or familiarity; social relationships; and clients' mobility. Spatial, temporal, and social factors intersected in unique ways in FSW's mobility experiences, yet distinct mobility typologies were evident across settings and destinations. Together, mobility narratives of FSW living with HIV can inform quantitative research on mobility typologies in Tanzania, the Dominican Republic, and elsewhere. With the potential for economic circumstances, climate change, and other emergencies to increase people's mobility around the world, researchers and practitioners can learn from the lived experiences of FSW to inform whether and how to tailor and improve the accessibility of HIV care and treatment interventions based on spatial, temporal, and social characteristics of mobility.

Risk and Protective Factors for Firearm Assault Injuries Among Black Men: A Scoping Review of Research.

Black men are disproportionately affected by firearm assaults in the United States, and these disparities are rooted in structural and social inequities. The objective of this scoping review of research was to identify risk and protective factors for firearm assault injuries among Black men at all levels of the social-ecological framework. The search was conducted in 2021. The initial search generated 1,122 articles. Studies were eligible if they (a) included an analysis of modifiable risk or protective factors for firearm assaults among Black men; (b) reported an estimate of correlation, association, or effect between risk or protective factors and firearm assault injuries, firearm violence, and/or firearm homicides; and (c) were published peer-reviewed articles. In all, 19 articles were identified for review. Risk factors identified at each ecological level include the following: (1) Individual: firearm possession/weapon use and criminal legal system interaction; (2) Relationships: gang membership and exposure to other people who have experienced a firearm assault; (3) Community: indicators for socioeconomic status and racial residential segregation; and (4) Societal: historical racist policy. Individual-level substance use had mixed results. Few (26%) studies examined protective factors at any ecological level, but community-level factors like neighborhood tree cover were identified. Future research needs to examine risk and protective factors at the societal level and multiple ecological levels simultaneously leading to more effective multi-level interventions that will guide policy formation. A greater diversity of study designs, research methods, and theoretical frameworks is needed to better understand factors associated with firearm assault among Black men.

Differences in Perceptions of Gun-Related Safety by Race and Gun Ownership in the United States.

Motivated by disparities in gun violence, sharp increases in gun ownership, and a changing gun policy landscape, we conducted a nationally representative survey of U.S. adults (n=2,778) in 2021 to compare safety-related views of white, Black, and Hispanic gun owners and non-owners. Black gun owners were most aware of homicide disparities and least expecting of personal safety improvements from gun ownership or more permissive gun carrying. Non-owner views differed. Health equity and policy opportunities are discussed.

An intersectional analysis of historical and contemporary structural racism on non-fatal shootings in Baltimore, Maryland.

Introduction Non-fatal shooting rates vary tremendously within cities in the USA. Factors related to structural racism (both historical and contemporary) could help explain differences in non-fatal shooting rates at the neighbourhood level. Most research assessing the relationship between structural racism and firearm violence only includes one dimension of structural racism. Our study uses an intersectional approach to examine how the interaction of two forms of structural racism is associated with spatial non-fatal shooting disparities in Baltimore, Maryland. Methods We present three additive interaction measures to describe the relationship between historical redlining and contemporary racialized economic segregation on neighbourhood-level non-fatal shootings. Results Our findings revealed that sustained disadvantage census tracts (tracts that experience contemporary socioeconomic disadvantage and were historically redlined) have the highest burden of non-fatal shootings. Sustained disadvantage tracts had on average 24 more non-fatal shootings a year per 10 000 residents compared with similarly populated sustained advantage tracts (tracts that experience contemporary socioeconomic advantage and were not historically redlined). Moreover, we found that between 2015 and 2019, the interaction between redlining and racialized economic segregation explained over one-third of non-fatal shootings (approximately 650 shootings) in sustained disadvantage tracts. Conclusion These findings suggest that the intersection of historical and contemporary structural racism is a fundamental cause of firearm violence inequities in Baltimore. Intersectionality can advance injury prevention research and practice by (1) serving as an analytical tool to expose inequities in injury-related outcomes and (2) informing the development and implementation of injury prevention interventions and policies that prioritise health equity and racial justice.

Historical redlining and the epidemiology of present-day firearm violence in the United States: A multi-city analysis.

Firearm violence is a major cause of morbidity, mortality, and racial health disparities in the United States. Previous studies have identified associations between historically racist housing discrimination (i.e., redlining practices) and firearm violence; however, these studies generally have been limited to a single city and have yet to provide sufficient evidence through which to determine the extent and dynamics of the impact of this relationship across the country. The aim of our study was (1) to estimate the association of historical redlining on both violent and firearm death across the country in nested models; and (2) to examine spatial non-stationarity to determine whether the impact of historical redlining on violent and firearm death was the same across the U.S. We used multilevel Bayesian conditional autoregressive Poisson models to determine the relationship between redlining as illustrated through Home Owners' Loan Corporation maps and 2019 violent and firearm deaths at the ZIP code-level nested within 21 cities across the U.S. We found that at the ZIP code level, there was a dose-responsive relationship between HOLC grading and the incidence of present-day firearm deaths. In general, redlined ZIP codes had higher relative incidence of firearm deaths. Associations were not stable across cities. For example, associations were relatively stronger in Baltimore, MD and weaker in Los Angeles, CA. This research reinforces the findings of previous studies examining the impact of redlining on firearm death across the extent of the entire country in 21 cities and claim that HOLC grades are associated with present-day violence.

Spatial and neighborhood-level correlates of lay naloxone reversal events and service availability.

BACKGROUND: The opioid epidemic in the United States continues to surge, reaching record deaths from opioid and fentanyl overdoses in 2020. This study analyzes spatial and neighborhood correlates of free naloxone distribution sites as well as overdose and naloxone reversal events in Baltimore, Maryland, which has one of the highest overdose rates in the country. METHODS: Using data from a randomized clinical trial on HIV prevention among people using substances in Baltimore, Maryland, as well as demographic data from the US Census Bureau, we conducted: (1) exploratory spatial visualizations of census tracts' minimum distance to naloxone distribution sites, (2) univariable Wilcoxon rank-sum tests to compare census tracts on demographic metrics, and (3) bivariable and multivariable negative binomial regression models to assess associations between census tract characteristics and naloxone reversal events. RESULTS: Valid geographic data were provided for 518 overdose events involving either fentanyl or heroin in this study. Of these, 190 (37%) attempted naloxone reversal events were reported. Exploratory spatial visualization techniques suggest that most distribution sites are appropriately located near populations at high risk of overdose, but study findings also identify areas where drug use and overdoses occur that are located farther from distribution sites. In multivariable analyses, naloxone administration was significantly and inversely associated with distance to the nearest distribution site (incidence rate ratio (IRR)=0.72 per 1000m increase, 95% CI 0.59-0.89, p=0.002). CONCLUSION: Study findings emphasize the correlation between proximity to naloxone sites and utilization of resources, highlighting that physical proximity to harm reduction resources may contribute to uptake. Results further underscore that research on service accessibility and utilization must consider the spatial distribution of health services.

A longitudinal study of vaccine hesitancy attitudes and social influence as predictors of COVID-19 vaccine uptake in the US.

BACKGROUND: In many countries with high levels of COVID-19 vaccine access, uptake remains a major issue. We examined prospective predictors of COVID-19 vaccine uptake in a United States longitudinal study. METHODS: An online longitudinal study on COVID-19 and well-being assessed vaccine hesitancy attitudes, social norms, and uptake among 444 respondents who had completed both survey waves in March and June 2021. RESULTS: The mean sample age was 41, with 55% female, 71% white, 13% Black, and 6% Latinx. In March 2021, 14% had received at least one COVID-19 vaccine dose. By June 2021, 64% reported receiving at least one dose. In prospectively assessing predictors of vaccine uptake, we found strong correlations among five different vaccine hesitancy questions. In multivariable logistic regression models, family and friends discouraging vaccination (adjusted odds ratios [aOR] = .26, 95% CI = .07, .98), not knowing whom to believe about vaccine safety (aOR = .51, 95% CI = .27, .95), and concerns that shortcuts were taken with vaccine development (aOR = .43, 95% CI = .23, .81) were all independent predictors of lower vaccine uptake. Political conservatism, gender, education, and income were also independent predictors of reduced uptake. Vaccine hesitancy items were also modeled as a scale, and the scale was found to be strongly predictive of vaccine uptake. CONCLUSIONS: The findings highlight the importance of social norm interventions and suggest general and specific vaccine hesitancy attitudes, especially trust, should be considered in developing vaccine uptake programs.

Crowdsourced PrEP Promotion Messages for an HIV High-Burden Area: A Framework-Based Content Analysis.

Pre-exposure prophylaxis (PrEP) is an important and highly effective HIV prevention strategy, but its uptake remains low, particularly among marginalized populations at high risk of HIV. Innovative and community-driven promotion strategies, such as open contests, are needed to address disparities. This directed content analysis uses a PrEP-specific adaptation of the Information-Motivation-Behavioral Skills (IMB) model to identify themes related to PrEP use reflected in community-generated submissions (n = 73) from an open contest conducted to elicit crowdsourced health promotion messages on PrEP in Baltimore, Maryland. In addition to identifying eight of the themes from the adapted IMB model, this analysis also identified two novel salient themes in the motivation category: self-worth/self-love and self-care practice. Findings from this analysis can inform PrEP promotion efforts by pointing to salient themes identified from a community-driven approach that are less well represented in existing research.

Correlates of Levels of Willingness to Engage in Climate Change Actions in the United States.

While the majority of the American public believe climate change is occurring and are worried, few are engaged in climate change action. In this study, we assessed factors associated with the level of willingness to engage in climate change actions using an online, longitudinal US study of adults. Climate change action outcomes included the level of willingness to post materials online, take political actions, talk with peers about climate change, and donate to or help an organization. Predictors included climate change attitudes, environmental attitudes, political ideology, political party affiliation, and demographic variables. Most (72%) of the 644 respondents only talked about climate change with peers a few times a year or less, though 65% were very or extremely worried about climate change. Many respondents indicated a willingness to do somewhat or a lot more, from 38% willing to talk to peers to 25% for willing to take political actions. In multinomial regression models, the Climate Change Concern scale was strongly and consistently associated with willingness to engage in climate change action. These findings indicate a need to both identify those who are willing to act and finding activities that fit with their interests and availability.

Young black MSM's exposures to and discussions about PrEP while navigating geosocial networking apps.

Young Black gay, bisexual and other men who have sex with men (YBMSM) carry a disproportionate HIV burden perpetuated by exposure to sexual networks with higher untreated HIV prevalence and incidence. In Baltimore, these sexual networks include high utilization of geosocial networking apps (GSN-apps). Our prior work suggests these apps can be important access points for targeted interventions like PrEP. To inform online PrEP outreach we explored YBMSM GSN-app users' exposure to and discussions about PrEP while navigating apps. We actively recruited YBMSM (n=17) age 18-24 from the GSN-app most frequently reported by newly diagnosed HIV-infected MSM in Baltimore. Participants were recruited through direct messaging within the GSN-app while logged-on in high HIV transmission areas. Participants completed 60-90 minute semi-structured interviews, which were analyzed using a 3-stage analytic coding strategy. While some participants had not heard of PrEP, the majority described mentions or conversations about PrEP on GSN-apps. Three themes emerged: (1) Mistrust of PrEP, (2) Association with sexual promiscuity, and (3) Concerns about lack of protection from other STIs. Proper messaging, accurate information, and education are needed to account for the negative perceptions that surround PrEP; otherwise, continued underuse among YBMSM will expand rather than reduce HIV disparities.

There's an App for That: Using Geosocial Networking Apps to Access Young Black Gay, Bisexual, and other MSM at Risk for HIV.

PURPOSE: Young black gay, bisexual, and other MSM (YBMSM) that carry a disproportionate HIV burden in the US Geosocial networking applications (GSN apps) are environments that may increase HIV risk among users. This study explored the acceptability and feasibility of using these apps for HIV/sexually transmitted infection (STI) public health outreach. DESIGN: Semi-structured in-depth qualitative interviews. SETTING: A frequently reported GSN app for meeting sex partners by newly diagnosed HIV-infected MSM in Baltimore. PARTICIPANTS: Seventeen YBMSM aged 18 to 24 (mean = 21.5/SD = 1.8) who were logged-on to the GSN app in venues or census tracts in high HIV transmission areas. METHODS: Participants completed 60 to 90 minute semi-structured interviews, which were audio-recorded and transcribed. Interview data were analyzed in NVivo10 using categorical analysis and double-coded until consistency was achieved. RESULTS: Participants described GSN apps as acceptable and feasible resources for public health practitioners seeking to access YBMSM to provide HIV/STI treatment and prevention services and resources. Three themes emerged: (1) the need to authenticate public health messages to distinguish from spam; (2) improved access to YBMSM including opportunities to identify and access virtual congregations of youth in non-gay-related spaces; and (3) the importance of avoiding stigmatizing YBMSM when targeting sexual health messages. CONCLUSION: GSN apps have great potential as tools for identifying and engaging at-risk YBMSM. Additional work is needed to understand limitations of this medium, to develop strategies to engage YBMSM without further stigmatizing them, and to maximize their outreach potential.

HIV and STIs Among MSM in Tajikistan: Laboratory-Confirmed Diagnoses and Self-Reported Testing Behaviors.

Little is known about the prevalence and associations of HIV/STI diagnoses and testing behaviors among men who have sex with men (MSM) in Tajikistan. A non-governmental organization conducted a cross-sectional study of MSM (n = 502) assessing laboratory-confirmed HIV/STI diagnoses, HIV/STI testing behavior in the past 6 months, sociodemographics, HIV/STI risk factors, and victimization/discrimination. Overall, 2.6 % were diagnosed with HIV, 2.2 % with syphilis, 17.6 % with chlamydia, and 56.0 % with herpes. Recent testing rates were low for HIV (35.9 %) and STIs (14.1 %). Compared to MSM who completed university, MSM with a high school education or less had lower odds of recent HIV and STI testing; however, victimization and healthcare discrimination were associated with greater odds of recent STI testing. Given the low HIV prevalence, there is a window of opportunity to extinguish the epidemic before it worsens. Non-governmental organizations are indispensable for expanding testing strategies because they can efficiently reach MSM in Tajikistan.