[Show abstract][Hide abstract] ABSTRACT: Young men who have sex with men (YMSM) are at increased risk for HIV and STI infection. While encouraging HIV and STI testing among YMSM remains a public health priority, we know little about the cultural competency of providers offering HIV/STI tests to YMSM in public clinics. As part of a larger intervention study, we employed a mystery shopper methodology to evaluate the LGBT cultural competency and quality of services offered in HIV and STI testing sites in Southeast Michigan (n = 43).We trained and deployed mystery shoppers (n = 5) to evaluate the HIV and STI testing sites by undergoing routine HIV/STI testing. Two shoppers visited each site, recording their experiences using a checklist that assessed 13 domains, including the clinic's structural characteristics and interactions with testing providers. We used the site scores to examine the checklist's psychometric properties and tested whether site evaluations differed between sites only offering HIV testing (n = 14) versus those offering comprehensive HIV/STI testing (n = 29). On average, site scores were positive across domains. In bivariate comparisons by type of testing site, HIV testing sites were more likely than comprehensive HIV/STI testing clinics to ascertain experiences of intimate partner violence, offer action steps to achieve safer sex goals, and provide safer sex education. The developed checklist may be used as a quality assurance indicator to measure HIV/STI testing sites' performance when working with YMSM. Our findings also underscore the need to bolster providers' provision of safer sex education and behavioral counseling within comprehensive HIV/STI testing sites.
AIDS and Behavior 08/2015; in press(10). DOI:10.1007/s10461-015-1174-z · 3.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of the present study was to understand the extent to which urban African-American youth access information via the Internet for a variety of sexual health topics and to identify the conditions under which they find sexual health information. African-American heterosexual youth (N = 81; 15–17 years) residing in low-income neighborhoods completed semi-structured interviews. Data on access to and use of the Internet for sexual health information were extracted, coded, and charted. Access to the Internet was widespread. Nearly half of the respondents had used the Internet for sexual health information; a variety of topics were covered (e.g., HIV/STIs; condoms; communication; relationships). Notably, many youth accessed information in the context of a sex education assignment or through advertisements on social network sites (SNSs). Universal use of the Internet has not led to widespread use of digital media for sexual health information. The Internet continues to be an underutilized resource, but our findings suggest several pathways through which youth may be reached with sexual health information online. We identify several testable hypotheses, which can be explored in larger quantitative studies and which will enhance our ability to develop effective strategies to reach youth with legitimate sexual health information online.
Sexuality Research and Social Policy: Journal of NSRC 06/2015; 12(2). DOI:10.1007/s13178-014-0174-5 · 0.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The fear of negative reactions from friends and family members affects many human immunodeficiency virus (HIV)-positive adolescents' decisions regarding disclosure of their HIV status. The complex relationships and interplay among social support, fear of stigma, and disclosure of HIV status need to be better understood among youth living with HIV (YLHIV).
Social support from friends and family members and HIV status disclosure were examined among 402 youth, aged 12-24 years, living with HIV.
In separate analyses, (1) HIV-positive youth who reported more than one close friend and (2) HIV-positive youth who reported that friends and family members continued to socialize with them after disclosure of their HIV diagnosis, had higher levels of perceived social support overall (both p < .05). Furthermore, perceived social support did not differ significantly between those participants for whom no family member knew their HIV status and those for whom at least one family member knew their status (p = .13). Race/ethnicity, sexual orientation, education level, and current living situation were not associated with family's knowledge of the participants' HIV infection status (p > .07).
This investigation adds important information concerning YLHIV, whose early disclosure experiences may influence their resilience and future coping mechanisms regarding experienced stigma, and thus influence the length of time they conceal their HIV status, their decision to disclose their status, and potentially their decisions regarding treatment. Interventions and support systems to assist YLHIV with disclosure, as well as medical care, may improve their overall quality of life.
Published by Elsevier Inc.
Journal of Adolescent Health 05/2015; 57(1). DOI:10.1016/j.jadohealth.2015.03.002 · 3.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We examined the potential for increasing the reach of HIV testing to African American youths through the dissemination of oral-HIV testing. From 2012 through 2013 we examined the perceptions of alternatives to pharmacy dissemination of SITs in African American youths (5 focus groups) and service providers (4 focus groups), and conducted an ethnographic study of pharmacies (n = 10). Participants perceived significant advantages to delivering SITs through community health and services for adolescents (e.g., increased confidentiality, reduced stigma) over pharmacy dissemination. Given proper attention to fit, SIT dissemination could be facilitated through distribution by health and social service sites, and by improving elements of pharmacy dissemination. (Am J Public Health. Published online ahead of print April 23, 2015: e1-e4. doi:10.2105/AJPH.2014.302531).
American Journal of Public Health 04/2015; 105(S3):e1-e4. DOI:10.2105/AJPH.2014.302531 · 4.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sexually explicit material (SEM) (including Internet, video, and print) may play a key role in the lives of Black same-sex sexually active youth by providing the only information to learn about sexual development. There is limited school- and/or family-based sex education to serve as models for sexual behaviors for Black youth. We describe the role SEM plays in the sexual development of a sample of Black same-sex attracted (SSA) young adolescent males ages 15-19. Adolescents recruited from clinics, social networking sites, and through snowball sampling were invited to participate in a 90-min, semi-structured qualitative interview. Most participants described using SEM prior to their first same-sex sexual experience. Participants described using SEM primarily for sexual development, including learning about sexual organs and function, the mechanics of same-gender sex, and to negotiate one's sexual identity. Secondary functions were to determine readiness for sex; to learn about sexual performance, including understanding sexual roles and responsibilities (e.g., "top" or "bottom"); to introduce sexual performance scripts; and to develop models for how sex should feel (e.g., pleasure and pain). Youth also described engaging in sexual behaviors (including condom non-use and/or swallowing ejaculate) that were modeled on SEM. Comprehensive sexuality education programs should be designed to address the unmet needs of young, Black SSA men, with explicit focus on sexual roles and behaviors that may be inaccurately portrayed and/or involve sexual risk-taking (such as unprotected anal intercourse and swallowing ejaculate) in SEM. This work also calls for development of Internet-based HIV/STI prevention strategies targeting young Black SSA men who may be accessing SEM.
Archives of Sexual Behavior 02/2015; 44(3). DOI:10.1007/s10508-014-0416-x · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Young black gay/bisexual and other men who have sex with men (YB-GBMSM) living with HIV are at risk for poor engagement in HIV care. Relatively little is known about factors that impact engagement outcomes at various stages along the HIV care continuum in this specific population. The purpose of this analysis was to examine associations between various psychosocial factors and likelihood of engagement at each stage of the care continuum, among a geographically diverse sample of 132 YB-GBMSM living with HIV. Negative self-image, a component of HIV stigma, had an inverse association with early care seeking after HIV diagnosis (OR=1.05; 95% CI 1.01-1.10). Negative self-image was also inversely associated with adherence to medical appointments (OR=0.95; 95% CI 0.91-0.99), while employment (OR=0.30; 95% CI 0.12-0.75) and ethnic identity affirmation (OR=0.28; 95% CI 0.12-0.68) were both positively associated with appointment adherence. HIV-positive identity salience was associated with a higher likelihood of being on antiretroviral therapy (OR=1.06; 95% CI 1.02, 1.09). These findings highlight the importance of processes related to identity development, as both barriers and facilitators of engagement in care for HIV-positive YB-GBMSM.
AIDS PATIENT CARE and STDs 02/2015; 29(2):77-85. DOI:10.1089/apc.2014.0117 · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Southeast Michigan accounts for over 70 % of all HIV/STI cases in the state, with young men who have sex with men (YMSM) between the ages of 13 and 24 encumbering the largest burden in HIV/STI incidence. Using community-based participatory research principles, we developed and pilot tested a web-based, randomized control trial seeking to promote HIV/STI testing ("Get Connected!") among YMSM (N = 130; ages 15-24). Randomized participants completed a baseline assessment and shown a test-locator condition (control) or a tailored, personalized site (treatment). At 30-day follow-up, we found high acceptability among YMSM in both conditions, yet higher credibility of intervention content among YMSM in the treatment group (d = .55). Furthermore, 30 participants reported testing by following, with the majority of these participants (73.3 %; n = 22) completing the treatment condition, a clinically meaningful effect (d = .34) suggesting preliminary efficacy for the intervention. These results demonstrate the potential of the intervention, and suggest that a larger efficacy trial may be warranted.
AIDS and Behavior 02/2015; 19(10). DOI:10.1007/s10461-015-1009-y · 3.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study determined the prevalence and patterns of psychological symptoms in adolescents and young adults living with HIV (YLWH) in medical care and relationships between psychological symptoms, route and duration of infection, and antiretroviral treatment (ART). A clinic-based sample of 2032 YLWH (mean age 20.3 years), recruited from 20 adolescent medicine HIV clinics, completed a cross-sectional survey of health behaviors and psychological symptoms using the Brief Symptom Inventory (BSI). Overall, 17.5% of youth reported psychological symptoms greater than the normative threshold on the Global Severity Index. A wide variety of symptoms were reported. The prevalence of clinical symptoms was significantly greater in youth with behaviorally acquired HIV compared to those with perinatally acquired infection (20.6% vs. 10.8%, OR=2.06 in Multiple Logistic Regression (MLR)), and in those not taking ART that had been prescribed (29. 2% vs. 18.8%, OR=1.68 in MLR). Knowing one's HIV status for more than one year and disclosure of HIV status were not associated with fewer symptoms. A large proportion of YLWH have psychological symptoms and the prevalence is greatest among those with behaviorally acquired infection. The high rate of psychological symptoms for youth not taking ART that is prescribed is a cause for concern. Symptoms do not appear to be a transient reaction to diagnosis of HIV.
AIDS PATIENT CARE and STDs 01/2015; 29(4). DOI:10.1089/apc.2014.0113 · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: With the emphasis on structural-level interventions that target social determinants of human immunodeficiency virus (HIV) transmission to curb the HIV epidemic, there is a need to develop evaluation models that can detect changes in individual factors associated with HIV-related structural changes.
To describe whether structural changes developed and achieved by community coalitions are associated with an effect on individual factors associated with the risk of contracting HIV.
In this serial cross-sectional survey design, data were collected from 8 cities during 4 rounds of annual surveys from March 13, 2007, through July 29, 2010. Study recruitment took place at venues where the population of focus was known to congregate, such as clubs, bars, community centers, and low-income housing. The convenience sample of at-risk youth (persons aged 12-24 years) included 5337 individuals approached about the survey and 3142 (58.9%) who were screened for eligibility. Of the 2607 eligible participants, 2559 (98.2%) ultimately agreed to participate.
Achievement of locally identified structural changes that targeted public and private entities (eg, federal agencies, homeless shelters, and school systems) with the goal of fostering changes in policy and practice to ultimately facilitate positive behavioral changes aimed at preventing HIV.
Number of sexual partners, partner characteristics, condom use, and history of sexually transmitted infections and HIV testing.
Exposure to structural changes was not statistically significantly associated with any of the outcome measures, although some results were in the direction of a positive structural change effect (eg, a 10-unit increase in a structural change score had an odds ratio of 0.88 [95% CI, 0.76-1.03; P = .11] for having an older sexual partner and an odds ratio of 0.91 [95% CI, 0.60-1.39; P = .39] for using a condom half the time or less with a casual partner).
This study evaluated a broad representation of at-risk individuals and assessed the effect of numerous structural changes related to various HIV risk factors. No structural changes as measured in this study were associated with a statistically significant reduction in risk behaviors. These null findings underscore the need for a long-term approach in evaluating structural interventions and the development of more nuanced methods of quantifying and comparing structural-change initiatives and determining the appropriate strategies for evaluating effect.
[Show abstract][Hide abstract] ABSTRACT: Psychological distress among adolescents living with HIV (ALH) has been associated with risky behaviors including non-adherence to anti-retroviral therapy, leading to increased risk for AIDS morbidity and mortality. Efforts to establish the nature, prevalence, and impact of psychological distress among ALH in Uganda are hindered by the lack of culturally relevant assessment tools. The purpose of this study was to develop and test a measure for psychological distress for Ugandan ALH aged 12-19 years (N = 508; 53.1 % female). Using a mixed method approach, we developed and tested a 25-item checklist with six subscales-anhedonia, depressive-anxiety, isolation, suicidal ideation, sleep problems, and somatization. We found adequate reliability for the scale (α = 0.89), and a satisfactory measurement structure in our confirmatory factor analyses (RMSEA <1.0, and CFI and TLI >0.90). We discuss the potential use of this culturally sensitive scale to examine psychological distress among ALH in Uganda.
AIDS and Behavior 01/2015; 19(2). DOI:10.1007/s10461-014-0973-y · 3.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Numerous barriers to clinic-based HIV testing exist (e.g., stigmatization) for African American youth. These barriers may be addressed by new technology, specifically HIV self-implemented testing (SIT). We conducted a series of formative phase 3 translation studies (49 face-to-face interviews, 9 focus groups, 1 advisory panel review) among low-income African American youth (15-19 years) and providers of adolescent services in two US cities to identify potential translation difficulties of the OraQuick SIT. Based on content analysis, we found that providers and African American youth viewed SITs positively compared to clinic-based testing. Data suggest that SITs may reduce social stigma and privacy concerns and increase convenience and normalization of HIV testing. Challenges with SIT implementation include difficulties accessing confirmatory testing, coping with adverse outcomes, and instructional materials that may be inappropriate for low socioeconomic status (SES) persons. Study results underscore the need for translation studies to identify specific comprehension and implementation problems African American youth may have with oral SITs.
Translational Behavioral Medicine 01/2015; DOI:10.1007/s13142-015-0331-2
[Show abstract][Hide abstract] ABSTRACT: Background: As non-discrimination and inclusivity policies for LGBT populations are gradually enacted nationwide, community-based organizations and healthcare facilities are increasing their efforts to address the needs of this population. Given the CDC’s emphasis on regular HIV/STI testing among young men who have sex with men (YMSM), understanding how testing sites respond to notions of LGBT inclusivity and sensitivity is warranted.
Methods: We assessed testing sites in a five-county region of the Midwest on measures of LGBT inclusiveness. Five gay-identified evaluators “secret shopped” 47 HIV/STI testing sites, receiving HIV/STI tests as actual clients. Afterwards, evaluators completed a 50-item questionnaire and offered a qualitative impression of their experiences. At the end of data collection, we sent each site a letter describing our process and encouraging them to schedule a meeting to discuss the shoppers’ experiences at their agency. We offered a packet of personalized results, summarizing how they compared on various quantitative indicators to other sites, and providing feedback from the open-ended portion of the evaluation.
Results: Agency staff were eager for feedback; sixty-six percent of the sites requested to meet. Some staff admitted nervousness at receiving results, yet stated they ultimately wanted a chance to improve services. With few exceptions, agencies welcomed suggestions for creating more inclusive environments. They nevertheless identified barriers to doing so, including issues of funding, space, and hierarchical bureaucratic structures.
Conclusions: We discuss steps for moving toward greater sensitivity with LGBT clients and offer concrete suggestions for practitioners hoping to create a more welcoming testing environment.
142nd APHA Annual Meeting and Exposition 2014; 11/2014
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Research suggests a relationship between substance use and risk taking sexual behaviors in adolescents. The purpose of this study is to explore how substance use is used during FSSSE in YBSGLAs as a first step in identifying public health prevention strategies to reduce adverse outcomes observed in this group.
METHODS: Forty-five YBSGLAs, 15-19 years old, in Baltimore, MD who reported prior FSSSE were recruited to participate in a semi-structured interview from clinics, venue/community-based outreach, Internet and snowball sampling. Interviews were transcribed verbatim, coded independently by two coders, and analyzed using inductive open-coding.
RESULTS: Participant’s mean age 17.9 (SD 1.9). Mean age at first sex 13.8 (SD 2.6). Eighteen percent of participants reported alcohol use, 39% marijuana use, and 16% used both marijuana and alcohol before or during FSSSE. Two themes emerged around substance use with FSSSE. Those who used drugs/alcohol, it functioned to relieve stress and boost sexual drive. Reported effects were categorized into positive: increased sexual excitement/arousal, and enhanced sexual experience and satisfaction; and negative: engaging in unplanned/unprotected sex. Participants who did not report substance use described limited to no function during FSSSE. Reasons for non-use included parental influences and concern for personal health.
CONCLUSIONS: Substance use is often a part of the FSSSE in YBSGLAs. Youth reported that substances enhanced sexual experiences, but also increased risk-taking behaviors. This work highlights the need for substance use management in risk reduction strategies for adolescent boys contemplating FSSSE to reduce HIV-related health disparities in same gender loving men.
142nd APHA Annual Meeting and Exposition 2014; 11/2014
[Show abstract][Hide abstract] ABSTRACT: Background: Researchers acknowledge a need to examine early romantic relationships in YBSGLM because experiences of pleasure in such relationships may impact sexual trajectory and subsequent risk behaviors.
Methods: We recruited 45 urban YBSGLM (age 15-19) from clinics, venues, Internet (Jack’d), and snowball sampling to complete a baseline 90-minute, semi-structured interview in order to understand concepts of sexual pleasure/satisfaction during first same-sex penetrative experiences (FSSPE). Interviews were transcribed and analyzed using inductive open-coding to develop major themes.
Results: Mean age was 17.9 yrs (SD 1.9). Most (N=30, 68%) identified as gay. Median number of partners in the prior 6 months was 3.6 (range 0 - 32). Most (57%, N=24) described being extremely or very physically satisfied during first sex and 48% (n = 22) experienced an orgasm. Positive expectation of sex and three specific factors emerged around whether the experience was pleasurable: partner (partner type, physical aspects [penis size], attractiveness/emotional connection to partner), contextual (marijuana use before sex (relaxation), location, relationship status) and physical mechanism of sex (condom/lubrication use and position (top/bottom)). Youth used pleasure to validate sexuality, gain sexual experience and for sexual-role clarification.
Conclusions: This work highlights that pleasure may be critical for young men to sort through developmentally important aspects of sexual development and the complexity of pleasure in early sexual experiences. Further work should explore the impact of those experiences on future behavior in order to support healthy sexual decision-making and design public health strategies that reduce risk for HIV among YBSGLM.
142nd APHA Annual Meeting and Exposition 2014; 11/2014
[Show abstract][Hide abstract] ABSTRACT: Background: Young gay and bisexual men (YGBM; ages 18–24) are experiencing an increase in rates of HIV infection, with Black and Latino YGBM experiencing higher infection rates than White YGBM. Psychological factors are often implicated in YGBM’s HIV/AIDS risk behaviors. However, YGBM’s decision to forego condoms with a partner (i.e., decisional balance to use condoms; DBC) across racial/ethnic groups is inconclusive in the literature.
Methods: Using data from a cross-sectional web-survey of single YGBM across the United States (N=1380; ages 18-24; 9.9% Black; 18.6% Latino; 71.5% White), we performed three race-specific multivariate regression models to explore the association between psychological factors (i.e., depression, anxiety) and DBC, after adjusting for YGBM’s age and their perceived difficulty to implement safer-sex strategies.
Results: Latino participants were significantly more likely to have higher depressive symptoms in the last week than Black participants, and more likely to have higher anxiety symptoms than White and Black participants. In our race-specific regression analyses, we found that greater symptoms of depression were associated with lower DBC to use condoms among Black participants (b =-.268). Greater anxiety symptoms was associated with greater DBC to use condoms among Latinos (b =.207). We found no association between psychological variables and DBC among White participants.
Conclusions: Psychological factors may be differentially associated with decisional balance to use condoms across racial and ethnic group categories. Health promotion initiatives around condom use may benefit from culturally-tailored interventions that address psychosocial functioning and its role in YMSM's condom use decision-making.
142nd APHA Annual Meeting and Exposition 2014; 11/2014
[Show abstract][Hide abstract] ABSTRACT: This study will discuss the initial findings from an emergent, multiple-method and staged qualitative study focused on developing a baseline understanding of the health needs of lesbian, bisexual, intersex and transgender women living in Western Kenya. Young women are approximately four times more likely to become infected with HIV than young men in Kenya (KNBS 2010). Although these infections are attributed to sex with men, not all women who have sex with men engage in exclusive heterosexual sexual behavior. Initial ethnographic work with gay, bisexual , and men who have sex with men illustrated the visibility of lesbian/bisexual women and their unique sexual health needs. This study set forth to explore an area that has been largely absent from the literature or other formal documentation. Initial study questions were developed in collaboration with the research teams in Kenya and in the US. Questions focused on participants’ perspectives, their meanings, and their multiple subjective views. Interpretative framing was influenced by reflective, interpretative, holistic & contextually-bound analysis. Initial data collection and analysis with participants (N=16) demonstrate robust psycho-social and medical needs and suggest the need for further exploration in the following four areas: 1).The lived experiences of Kenyan lesbian/bisexual women, 2). The factors which impact risk and resilience, 3). Documentation of the psychosocial and medical needs of lesbian/bisexual women, and 4). The unique experiences and needs of intersex and transgender women. Finally, future directions for inquiry will be discussed.
142nd APHA Annual Meeting and Exposition 2014; 11/2014