Changes in Sexual Behaviors Due to Mpox: a Cross-Sectional Study of Sexual and Gender Minority Individuals in Illinois.

The spread of the monkeypox virus (mpox) in 2022 primarily within the sexual networks of men who have sex with men (MSM) triggered a potentially stigmatizing public health response in the USA. Despite mpox being primarily spread through skin-to-skin contact, most messaging has promoted abstinence and/or reduction in sexual risk behaviors. More research is needed on decreases in sexual risk behaviors among sexual and gender minority (SGM) youth and young adults (YYA) related to the most recent mpox epidemic and whether there are factors associated with these decreases in sexual risk behavior. Participants within an ongoing cohort study of SGM YYA who reside in Illinois were offered the opportunity to participate in an mpox survey between September 10th and September 20th, 2022. Analyses looked at demographic factors associated with sexual activity since the start of the outbreak, as well as associations with two sexual risk reduction factors. Survey participation was 68.7% (322/469). Three-quarters of participants (82.6%) reported sexual activity since June 1st. Most sexually active participants (83.5%) adopted at least one sexual risk reduction behavior due to mpox. Black and Latinx individuals were less likely to be sexually active but more likely to report risk reduction behaviors (31.3% and 22.6%, respectively). Participants who received the mpox vaccine were more likely to report sexual activity. SGM YYA in Illinois reported that their sexual behaviors were impacted by the mpox outbreak. However, associations between vaccination and sexual behavior demonstrate that those who are vaccinated do adopt protective methods despite not decreasing sexual activity. Therefore, sex-positive communications and harm reduction messaging may be more appropriate as opposed to abstinence-only prevention, which can further stigmatize an already marginalized group.

Monkeypox-Induced Secondary Traumatic Stress: An Exploratory Analysis of Young Sexual and Gender Minority Adults Living in Illinois.

Objective: Prior epidemic literature suggests that the rapid proliferation of Monkeypox (Mpox) within the United States may trigger severe stress reactions that increase the risk of developing secondary traumatic stress among young adults most at risk of exposure. The present exploratory study aimed to investigate the degree to which proximity to Mpox (i.e. knowing people who acquired Mpox), was associated with symptoms of secondary traumatization. Method: An online survey was administered to 253 participants enrolled in Keeping it LITE, a prospective U.S. cohort study of ethnically diverse, sexually active, sexual and gender minority persons ages 19-39 in September 2022. A multiple linear regression was used to examine the association between proximity to Mpox and secondary traumatic stress (STS) symptoms. Results: Study findings demonstrated that Mpox morbidity was low (1%); however, 37% of participants reported knowing at least one person diagnosed with Mpox. For most individuals, this person was a friend (28%). 16% of participants were found to have at least one indicator of Mpox-related STS. Results of our multiple linear regression demonstrated a positive association between an individual's indirect exposure to Mpox via their interpersonal relationships and STS symptoms. Conclusions: Findings suggest that the more adults' interpersonal relationships are saturated with people who have acquired Mpox, the more likely they are to develop symptoms of secondary traumatization. These findings provide tentative initial evidence that secondary exposure to Mpox via one's social network may undermine adults' mental health even after the conclusion of the outbreak.

Predictors of Mpox vaccine uptake among sexual and gender minority young adults living in Illinois: Unvaccinated vs. double vs. single dose vaccine recipients.

INTRODUCTION: The 2022 global outbreak of Monkeypox virus (Mpox), which has primarily spread through the sexual networks of sexual and gender minority (SGM) individuals, has introduced new public health challenges. While an efficacious Mpox vaccine is in active circulation, few Mpox vaccine studies have examined its uptake among SGM groups. The aims of this study were to investigate (a) the prevalence of Mpox vaccine uptake among SGM and (b) the contextual, Mpox-disease specific, and Mpox-vaccine specific factors associated with Mpox vaccine among SGM. METHODS: We conducted a cross-sectional survey in Illinois, USA in September 2022; 320 young SGM completed self-administered questionnaires. Multinomial logistic regression was used to assess the contextual, Mpox-disease specific, and Mpox-vaccine specific factors associated with Mpox vaccine uptake. Adjusted Odds Ratios (aORs) and 95 % Confidence Intervals (CI) are reported. RESULTS: Approximately 50 % of the SGM participants included in this study had received at least their first dose of the Mpox vaccine. Multinomial regression analysis showed that individuals who had recently experienced food insecurity, had higher degrees of fear of social rejection due to Mpox acquisition, and were more Mpox-vaccine hesitant were more likely to be unvaccinated. Conversely, knowing people who have contracted Mpox, having higher formal educational attainment, having higher degrees of Mpox-related internalized heterosexism, and being more concerned about one's safety regarding Mpox morbidity were more likely to be double-dosers. CONCLUSION: Approximately 50 % of the SGMs included in this study received at least their first dose of the Mpox vaccine; however, only one-quarter of participants completed the recommended 2-dose Mpox regimen. Our findings indicate that socioeconomic stability, fear of social rejection due to disease acquisition, and Mpox-specific vaccine hesitancy may be important structural targets to consider when developing vaccine-uptake prevention and intervention strategies tailored to the needs of sexual and gender minorities.

Access to healthcare among sexual and gender minority youth at risk for HIV: barriers and experiences of discrimination.

This study examined experiences of healthcare inaccessibility and lesbian, gay, bisexual, transgender, queer, plus (LGBTQ+) discrimination among sexual and gender minority youth at elevated risk for HIV in the United States. Participants for this cross-sectional survey study (N = 3330) were cisgender men, transgender men and women, and nonbinary individuals ages 18-34 recruited for a larger study examining HIV risk behavior between December 2017 and December 2019. Results indicated that 41.1% of participants had at least one lifetime experience of LGBTQ + healthcare discrimination, and 44.1% reported past 6-month experiences of discrimination or problems accessing healthcare. Transgender men and women were more likely than cisgender men and nonbinary participants to report experiences of discrimination, and transgender men were more likely to report problems accessing healthcare. A majority of participants (72.8%) reported that their most recent healthcare provider was aware of their sexual or gender identity. These results indicate a high prevalence of structural barriers in healthcare access for sexual and gender minority youth at elevated risk for HIV, including finical and logistical barriers as well as anticipated and experienced discrimination. We discuss these findings and highlight the importance of easily accessible and culturally competent care for this community.

Experiences of Online Racialized Sexual Discrimination among Sexual and Gender Minorities in the United States: Online Survey Data from Keeping It LITE.

This study sought to analyze prevalence and correlates of online racialized sexual discrimination (RSD), or sexualized discriminatory treatment, in the context of sexualized encounters, among cisgender men and transgender individuals who have sex with men at risk for HIV. Data were collected as part of a baseline survey from a large national sample (N = 2,166). Among participants of color (N = 1,042), 84.9% had experienced RSD in the past 6 months, and transgender participants experienced similar levels of RSD as cisgender men. Experience of RSD was associated with older age and more frequent experiences of general discrimination, but not with geographic location, mental health symptoms, sexual risk behavior, or internalized homonegativity. These findings confirm that RSD is highly prevalent among sexual and gender minority individuals of color who have sex with men. Implications and areas for future research are discussed.

Individual and structural-level Correlates of Pre-exposure Prophylaxis (PrEP) lifetime and current use in a nationwide sample of young sexual and gender minorities.

The objective of this analysis was to describe individual and structural-level factors associated with pre-exposure prophylaxis (PrEP) use among a sample of sexual and gender minorities (SGM) at risk for HIV recruited using limited interaction strategies. SGM (N = 3330), ages 15-34, without HIV enrolled in a nationwide limited interaction cohort study from 2017 to 2020. A baseline cross-sectional single-survey design examined individual and structural-level correlates of PrEP lifetime use and current use using logistic regression. PrEP lifetime use and current use were reported by 31.2% and 23.9%, respectively, of SGM with PrEP data (n = 3077). PrEP use outcomes (lifetime or current use) in cisgender MSM were associated with being over age 18, Black or other race, Hispanic/Latina/x/o ethnicity, being gay, being out to one's healthcare provider, having health insurance, being a college graduate, and having a greater number of PrEP peers. PrEP use outcomes (lifetime use or current use) in transgender/non-binary participants were associated with being over age 24, being Latinx, being transgender vs. non-binary, being assigned male at birth, being out to their healthcare provider, living in the western or northeastern United States, and having more peers on PrEP. More work is needed to address lower PrEP uptake in SGM under 18 and those whose sex risk may be more dynamic (e.g., non-binary, pansexual/queer, and bisexual SGM) and such strategies should consider utilizing peers to provide information and ameliorate structural barriers.

RESUMEN: Este análisis describe los determinantes sociales asociados con el uso de la PrEP entre una cohorte contemporánea de minorías sexuales y de género (MSG) en riesgo de contraer el VIH en los Estados Unidos. Los participantes incluyeron MSG (N = 3330), de 15 a 34 años, sin VIH reclutados por redes sociales entre 2017­2020. Usando los datos de inscripción, una regresión analizó la historia del uso de la PrEP. Los factores asociados con el uso de la PrEP entre este grupo indicaron que los mayores de edad, los abiertos sobre su sexualidad con sus médicos, y los que conocían compañeros que usaban la PrEP, todos eran más propensos a haber usado la PrEP. Más esfuerzo se requiere para abordar el uso de la PrEP entre aquellos cuyos su riesgo sexual puede ser más dinámico.

Limited Interaction Targeted Epidemiology of HIV in Sexual and Gender Minority American Adolescents and Adults: Feasibility of the Keeping it LITE Study.

BACKGROUND: HIV infection rates among sexual minority men and transgender individuals, particularly adolescents and young adults, remain elevated in the United States despite continued improvement in the HIV public health response. However, there remains a knowledge gap in understanding the barriers faced by this community in receiving HIV care and prevention resources. To address this, the Keeping it LITE study was conducted to assess HIV risk factors and barriers to preventive treatment in a large national cohort of young sexual minority men and transgender individuals at high risk of HIV infection. OBJECTIVE: This study aims to evaluate the feasibility of enrolling a large remote cohort, challenges encountered in recruitment, and adjustments made to address these challenges. METHODS: A large national cohort (n=3444) of young sexual minority men and transgender individuals were recruited. Participants were recruited via advertisements on social media; social apps for lesbian, gay, bisexual, transgender, and queer individuals; print advertising; and word-of-mouth. Before enrolling, participants verified their HIV status using an at-home HIV test or by providing their own testing documentation. Descriptive statistics were generated, and a series of logistic regressions were conducted to evaluate demographic differences between recruitment methods, HIV testing methods, and enrollment status. RESULTS: The Keeping it LITE study was particularly successful in recruiting participants via social media, with over half of the participants recruited from advertisements on social media platforms such as Facebook, Instagram, and Snapchat. Participants were also recruited via word-of-mouth; lesbian, gay, bisexual, transgender, and queer apps (ie, Grindr, Scruff); and print advertisements, and participants recruited from these sources tended to be older and have a higher risk profile. The study was also successful in recruiting a large sample of transgender youth, particularly transgender men and nonbinary individuals. At-home HIV testing was acceptable and more heavily used by younger participants, although several barriers were encountered and overcome in the implementation of this testing. The study had more limited success in recruiting participants aged 13-17 years because of lower enrollment rates and barriers to advertising on social media platforms. The implications of these findings for the future development of HIV research and intervention protocols among sexual minorities and trans youth are discussed. CONCLUSIONS: The methods used in the Keeping it LITE study, particularly recruitment via social media, were found to be feasible and acceptable to participants.

Effect of Truvada lawsuit advertising on preexposure prophylaxis attitudes and decisions among sexual and gender minority youth and young adults at risk for HIV.

OBJECTIVE: In 2019, US advocates reported misleading language regarding the safety of TDF/FTC (Truvada) used by lawsuit advertisements against Gilead Sciences. We sought to ascertain the reach and effects of the advertisements on preexposure prophylaxis (PrEP) opinions and decisions in a cohort of youth and young adults at-risk for HIV. DESIGN: An online survey was administered to participants enrolled in Keeping it LITE, a prospective US cohort study of ethnically diverse, sexually active, cisgender and transgender persons ages 13-37. METHODS: Quantitative data were analyzed using descriptive and inferential analysis in SAS, and qualitative data via thematic analysis. RESULTS: Survey response rate was 51.3% (n = 1485). Mean age at baseline was 24. Previous PrEP use was reported by 43% of respondents and 32.7% reported PrEP use in the past 6 months. Almost half (48.7%) were aware of the lawsuit. Most of these participants (81.3%) reported the advertisements did not impact their PrEP use, but 13.2% decided to not to begin a Truvada-based PrEP regimen and 5.5% decided to stop taking Truvada due to the advertisements claims. Predictors of changing PrEP behavior were lower education and no previous PrEP use. The qualitative analysis revealed the advertisements increased skepticism about safety and benefit of Truvada PrEP and led to greater distrust of the pharmaceutical industry. CONCLUSION: The advertisements reached a large, diverse US audience. Disturbingly, 18.7% of PrEP candidates who were aware of the lawsuit attributed not initiating or cessation of a Truvada-based PrEP regimen to exposure to the Truvada lawsuit advertisements.

The Internet's Multiple Roles in Facilitating the Sexual Orientation Identity Development of Gay and Bisexual Male Adolescents.

One emerging avenue for the exploration of adolescents' sexual orientation identity development is the Internet, since it allows for varying degrees of anonymity and exploration. The purpose of this phenomenological study was to examine the role of the Internet in facilitating the sexual orientation identity development process of gay and bisexual male adolescents. Qualitative interviews were conducted with an ethnically diverse sample of 63 gay/bisexual male adolescents (ages 15-23). Participants reported using a range of Internet applications as they explored and came to accept their sexual orientation identity, with the intended purpose and degree of anonymity desired determining which applications were used. Youth reported that the Internet provided a range of functions with regard to the exploration and acceptance of their sexual orientation identity, including (1) increasing self-awareness of sexual orientation identity, (2) learning about gay/bisexual community life, (3) communicating with other gay/bisexual people, (4) meeting other gay/bisexual people, (5) finding comfort and acceptance with sexual orientation, and (6) facilitating the coming out process. Future research and practice may explore the Internet as a platform for promoting the healthy development of gay and bisexual male adolescents by providing a developmentally and culturally appropriate venue for the exploration and subsequent commitment to an integrated sexual orientation identity.

Integrating Behavioral HIV Interventions into Biomedical Prevention Trials with Youth: Lessons from Chicago's Project PrEPare.

On the heels of several trials demonstrating the efficacy of pre-exposure prophylaxis (PrEP) and the recent approval by the FDA of the supplemental indication for Truvada as PrEP, researchers, advocates, and community providers are calling for the investigation of implementation strategies that combine behavioral interventions with biomedical prevention. This paper describes the modification and integration of an evidence-based group-level intervention into a small PrEP pilot trial with young men who have sex with men (YMSM). The behavioral intervention as well as ongoing risk reduction counseling sessions were found to be highly acceptable among a sample of racially diverse YMSM.

Engineering of nondiffracting beams with genetic algorithms.

We introduce a technique to generate arbitrary nondiffracting beams. Using a genetic algorithm that uses a Gaussian weight function merged with spatial spectrum engineering techniques, we show that it is possible to obtain the angular spectrum representation of arbitrary light patterns, thus demonstrating their nondiffracting properties.

La estimulación del receptor dopaminérgico central en el hipertenso esencial mediante el uso de amantadina / The stimulation of the central dopaminergic receptori in the essential hypertensive patient by use of amantadine

Actualmente, se han ido acumulando evidencias indicativas de que algunas estructuras nerviosas centrales, de naturaleza dopaminérgica, que se extienden desde la médula oblongada hasta el sistema límbico, intervienen primariamente en el control de la presión arterial (PA) sistémica. De acuerdo con diversos estudios experimentales y clínicos, se ha sugerido la hipótesis de que un defecto funcional del sistema dopaminérgico central podría estar involucrado en la etiopatogenia de la hipertensión esencial (HE). Con el propósito de analizar dicha hipótesis, se estudio el efecto del agonista de la dopamina (DA), amantadina (Am) sobre la frecuencia cardiaca (FC), la PA, la noradrenalina (NA), la adrenalina (A), el ácido vainillilmandélico (AVM), y el ácido homovainíllico (AHV) urinarios, en 19 mujeres con HE establecida. El estudio comprendió 2 periodos: "placebe" y "droga", cada uno de 22 días, con toma de la FC y de la PA en clino y en ortostatismo, cada 3-4 días; al finalizar cada período se cuantificaron las CA y sus metabolitos. Durante el período droga se administró clorhidrato de amantadina (300 mg/día), por vía oral, en dosis fraccionada. Con el fármaco, la FC no se modificó con respecto al período placebo; pero la PA en ambas posiciones, asi como las CAP, la NA y el AHV, mostraron una disminución que fue altamente significativa; la A y el AVM, presentaron un descenso menos significativo desde el punto de vista estatístico

Feocromocitoma y catecolaminas. Experiencia en 63 casos estudiados durante 25 anos. / Pheocromocytoma and catecholamines: 63 cases studied over 25 years

Se presenta la utilidad de la cuantificacion fluorometrica de las catecolaminas en el diagnostico de feocromocitoma.En los 63 casos estudiados durante 25 anos, en este Instituto Nacional de Cardiologia Ignacio Chavez, de Mexico, se midieron simultaneamente las catecolaminas plasmaticas y adrenalina (A), noradrenalina (N) y acido vainillilmandelico (AVM) en orina, lo que permitio establecer el diagnostico de la existencia del tumor cromafin en todos los casos. La excrecion de adrenalina fue mas alta en los pacientes con tumor localizado en la suprarrenal mientras que la noradrenalina estuvo mas elevada en los de localizacion extrasuprarrenal. Los pacientes con tumores menores de 50 gms tuvieron excrecion de A + N mas elevada y de AVM mas baja en comparacion con los que tenian tumoracion de mayor peso, y por tanto la relacion AVM/A + N fue mas baja. Se concluye que la determinacion simultanea de CP, A, N y AVM, permiten hacer el diagnostico correcto en la mayoria de los pacientes con feocromocitoma. Por otra parte, el aumento predominante de A en orina sugiere la localizacion suprarrenal de la neoplasia

Aldosteronismo primario. Aspectos diagnosticos y de tratamiento. / Primary aldosteronism. Diagnostic and therapeutic aspects

No obstante la relativa baja frecuencia de aldosteronismo primario (AP), su diagnostico tiene gran importancia ya que el tratamiento quirurgico resulta, en la mayoria de los casos, en la puracion de la hipertension arterial (HTA). En el presente trabajo se informan seis casos con este tipo de hipertension arterial secundaria. El padecimiento se sospecho por la coexistencia de HTA e hipokalemia. El descenso de potasio serico en respuesta a carga oral de sal mostro ser un dato de gran utilidad para el diagnostico. En los cinco pacientes intervenidos quirurgicamente, la extirpacion del aldosteronoma normalizo la presion arterial y corrigio las alteraciones bioquimicas. En cuatro de ellos, el tumor se encontro en la suprarrenal izquierda y en uno en la derecha. Un paciente no sometido a cirugia, se ha mantenido normotenso con espironolactona. Estos datos confirman lo descrito en la literatura y enfatizan la trascendencia del diagnostico y tratamiento adecuado en los pacientes con esta forma de hipertension arterial