Instructions, with Illustrations, for the Self-Collected Rectal Swab for Gonorrhea and Chlamydia Testing (Aptima CA2, Hologic, San Diego, California).
The MARI Study.

Instructions, with Illustrations, for the Self-Collected Rectal Swab for Gonorrhea and Chlamydia Testing (Aptima CA2, Hologic, San Diego, California). The MARI Study.

Source publication
Article
Full-text available
Background: This paper describes the rationale, design, and methodology of the Ecological Study of Sexual Behaviors and HIV/STI among African American Men Who Have Sex with Men (MSM) in the Southeastern United States (U.S.; known locally simply as the MARI Study). Methods: Participants are African American MSM aged 18 years and older residing in...

Similar publications

Article
Full-text available
Background: Many women living with HIV experience gendered power inequalities, particularly in their intimate relationships, that prevent them from achieving optimal sexual and reproductive health (SRH) and exercising their rights. We assessed the effectiveness of interventions to improve self-efficacy and empowerment of women living with HIV to m...

Citations

... By interrogating this theme, we identified two types of reasoning processes they used to evaluate their HIV risk: interpersonal and intrapersonal. Their perceptions of risk existed within the context of the HIV environmental "riskscape," the environment in which there exists both protective and risk factors associated with HIV acquisition [36,37]. ...
Article
Full-text available
Black men who have sex with men (MSM) are disproportionately burdened by the HIV epidemic. Although there has been an increased focus on reducing HIV prevalence in Black MSM, little attention has been given to how and why Black MSM are able to remain HIV-negative, beyond believing that they are lucky. The purpose of this qualitative study was to explore how Black MSM try to stay HIV-negative. Guided by constructivist grounded theory and a strengths-based approach, we conducted in-depth interviews to explicate how Black MSM demonstrate resilience by staying seronegative amidst high seroprevalence. Results from this study suggest that it is their perceptions of HIV risk that translate into protective strategies that enable them to prevent infection. Our study offers insight into their reasoning processes that guide their efforts to stay HIV-negative.
... Data were derived from a population-based study initiated in Jackson, MS, and Atlanta, GA, to identify multi-level correlates of HIV risk among BSMM (Hickson et al., 2015). Locally, the study was referred to as "The MARI Study," but was not affiliated with the Minority HIV/AIDS Research Initiative sponsored by the CDC (Sutton et al., 2013). ...
Article
Full-text available
HIV/STI disparities are highest among Black sexual minority men (BSMM) and Black transwomen (BTW) in the Deep South. Exploring the prevalence and correlates of rectal douching and enema use could provide insights into risk factors and HIV/STI prevention opportunities among these groups. This study explored the prevalence and correlates of rectal douching and enema using Poisson regression models among 375 BSMM and BTW in Jackson, MS, and Atlanta GA. Approximately 95% reported their gender as male/man; 5.6% self-identified as transwomen. Most reported being single (73.1%) and were unemployed (56.0%); 36.1% were previously diagnosed with HIV. In multivariable models, BSMM and BTW who reported that their typical sexual position during anal sex was “bottom” (aPR = 2.39, 95% CI = 1.48, 3.84) or “versatile” (aPR = 2.46, 95% CI = 1.44, 4.17) had a higher prevalence of rectal douching and enema use than those who reported “top.” Deeper understanding of the contexts of rectal douching, enema use, and sexual positioning practices is needed.
... The MARI study was conducted in two cities in the U.S. Deep South: Jackson, Mississippi and Atlanta, Georgia between 2013 and 2014. Broadly, the study aimed to describe and explicate the "environmental riskscape" for HIV among Black SMM and transgender women (Hickson et al., 2015). We compensated participants $35, which we eventually increased to $50 to promote study enrollment. ...
Article
Full-text available
Although racial sexual exclusivity among Black gay, bisexual, and other sexual minority men (SMM) is frequently framed as a cause of HIV inequities, little research has examined how these sexual relationships may be driven by and protective against racism. This study examined associations between general racial discrimination, Black sexual exclusivity, sexual racial discrimination, and depressive symptoms among Black SMM. We conducted analyses on cross-sectional self-report data from 312 cisgender Black SMM in the U.S. Deep South who participated in the MARI study. Measures included general racial and sexual identity discrimination, race/ethnicity of sexual partners, sexual racial discrimination, and depressive symptoms. We estimated a moderated-mediation model with associations from discrimination to Black sexual exclusivity, moderated by discrimination target, from Black sexual exclusivity to sexual racial discrimination, and from sexual racial discrimination to depressive symptoms. We tested an indirect effect from racial discrimination to depressive symptoms to examine whether Black sexual exclusivity functioned as an intervening variable in the associations between racial discrimination and depressive symptoms. Results indicated that participants who experienced racial discrimination were more likely to exclusively have sex with Black men. Men with higher Black sexual exclusivity were less likely to experience sexual racial discrimination and, in turn, reported lower depressive symptoms. The indirect pathway from racial discrimination to depressive symptoms through Black sexual exclusivity and sexual racial discrimination was significant. Our results suggest that one of the drivers of sexual exclusivity among Black SMM may be that it helps to protect against the caustic psychological effects of racial discrimination.
... Broadly, the study aimed to describe and explore the environmental, behavioural, sociodemographic and HIV risk behaviours among Black gay and bisexual men and included a limited number of Black transgender women. 22 Participants were given US$35 (which later increased to US$50 to bolster participation). Data were collected from July 2013 in Jackson and from December 2014 in Atlanta until the end of 2015. ...
Article
Objectives The purpose of the present study was to examine associations between life stress and incarceration history in relation to sexual health risk practices among a sample of cisgender Black gay, bisexual and other men who have sex with men (MSM) in the Deep South. Methods: Using data from a sample of 355 cisgender Black MSM in Mississippi and Georgia, multivariable logistic regression analyses were conducted to examine associations between life stress and sexual risk practices. In addition, we assessed whether stress may interact with experiences of incarceration to influence sexual health risk practices. Results: After controlling for sociodemographic characteristics, stress was associated with some sexual risk practices (e.g. alcohol and drug use during sex and group sex). Further, when an interaction with incarceration was assessed, among participants who had been incarcerated, high compared with low levels of stress were associated with alcohol use during sex (adjusted odds ratio (aOR) 4.59, 95% confidence interval (CI) 2.11-9.99, P < 0.001), drug use during sex (aOR 3.92, 95% CI 1.79-8.60, P < 0.001), condomless sex with casual partners (aOR 2.83, 95% CI 1.31-6.12, P < 0.001), having six or more casual partners (aOR 2.77, 95% CI 1.09-7.06, P = 0.02) and participating in group sex (aOR 5.67, 95% CI 2.07-15.51, P < 0.001). Stress and incarceration produced a dose-response effect for each association; similar associations with stress were not observed among men who had not been incarcerated. Conclusions: Among people with experiences of incarceration, there are several possible ways our findings could be applied practically, including through safer sex and stress management interventions designed specifically for Black MSM following their release.
... Because the majority of neighborhood and HIV-related studies have been conducted among MSM populations in urban and non-Southern areas such as New York City and San Francisco, the MARI Study (which is a study of Black MSM in the Deep South) presents a unique opportunity to explore neighborhood environmental influences on sexual behaviors in an understudied region and highly marginalized population (Hickson et al., 2015). The purpose of this study was to examine associations between perceived neighborhood problems and sexual behaviors among a sample of Black MSM in the Deep South. ...
Article
Full-text available
There is a disproportionately high HIV incidence among Black men who have sex with men (MSM) despite equal or lower levels of HIV risk behaviors compared to White MSM. Due to high levels of racial segregation in the U.S., Black MSM have an elevated likelihood of living in neighborhoods that contain psychosocial stressors, which, in turn, may increase behaviors promoting HIV infection. We examined associations between perceived neighborhood problems and sexual behaviors among Black MSM in the Deep South, a population at highest risk of HIV. Data came from the MARI Study, which included Black MSM ages 18–66 years recruited from the Jackson, MS, and Atlanta, GA, metropolitan areas (n = 377). Participants completed questions about neighborhood problems (e.g., excessive noise, heavy traffic/speeding cars and trash/litter) and sexual behaviors (e.g., condomless sex and drug use before or during sex). We used Poisson’s regression model with robust standard errors to estimate the adjusted prevalence ratio (aPR; 95% confidence intervals [CI]) of neighborhood problems (coded as tertiles [tertile 1 = low neighborhood problems, tertile 2 = medium neighborhood problems, tertile 3 = high neighborhood problems] as well as continuously) with sexual behaviors, after adjustment for sociodemographic characteristics and other variables. About one-fourth of the sample reported at least one neighborhood problem, with the most common (31.6%) being no/poorly maintained sidewalks, which indicates an infrastructural problem. In multivariable models, compared to those in the lowest tertile, those reporting more neighborhood problems (tertile 2: aPR = 1.49, 95% CI = 1.04, 2.14 and tertile 3: aPR = 1.53, 95% CI = 1.05, 2.24) reported more drug use before or during sex (p for trend = .027). Neighborhood problems may promote behaviors (e.g., drug use before or during sex) conducive to HIV infection. Structural interventions could improve community infrastructure to reduce neighborhood problems (e.g., no/poorly maintained sidewalks and litter). These interventions may help to reduce HIV incidence among Black MSM in the Deep South.
... The Ecological Study of Sexual Behaviors and HIV/STIs among black/African American MSM in the Southeastern US Study was a two-city, population-based study designed to evaluate the multi-level contexts of HIV/STI risk and protective factors for black MSM in Jackson, MS and Atlanta, GA [9]. We enrolled participants from July 2013 through December 2016. ...
Article
Full-text available
Purpose Compare selected sociodemographic and sexual risk characteristics of black/African American (black) men who have sex with men only (MSMO) and men who have sex with men and women (MSMW) in the southeastern United States (the South). Methods We conducted bivariate and multivariable analyses to explore the sociodemographic characteristics and sexual risk behaviors of 584 MSMW and MSMO in the South. Results MSMW had lesser odds of having a college or graduate degree (aOR = 0.32; 95% CI = 0.19, 0.54) and having > 2 male oral sex partners (aOR = 0.20; 95% CI = 0.08, 0.48) compared to MSMO. MSMW had greater odds of being homeless (aOR = 3.11; 95% CI = 1.80, 5.38) and selecting “top” sexual position (aOR = 1.70; 95% CI = 1.07, 2.72) compared to MSMO. Conclusion MSMW in the South experience social and structural factors that may affect their risk for HIV infection. Strategies to address these factors should be considered in prevention and care efforts for this population.
... Studies have shown that sexual and substance-use risk behaviors do not fully account for the HIV disparities observed between YBMSM and other groups [3][4][5][6][7]. Instead, multiple socio-structural factors such as unstable housing, HIV stigma, limited access to HIV services, incarceration history, lack of safe spaces, and unemployment contribute to HIV vulnerability and poor HIV care and treatment outcomes for Black men [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Despite the burden of HIV among young Black men, there is a dearth of holistic health interventions that simultaneously address the numerous and co-occurring socio-structural barriers to HIV services [12][13][14][15]. ...
Article
Background We describe the background, rationale, intervention components, and formative results of a demonstration project aimed to ameliorate five socio-structural barriers to HIV services for young Black men aged 18–29 living with and at risk for HIV in Louisiana. Methods The interventions and activities consisted of (1) five person-centered approaches to enhance linkage to HIV services and improve socio-economic outcomes; (2) the implementation of systematic mystery shopping tests to document instances of housing discrimination; (3) the development and implementation of a multi-prong communications campaign to increase knowledge about the signs of housing discrimination and community resources among young Black men who have sex with men (YBMSM); (4) the integration of HIV/STI services and lesbian, gay, bisexual, and trans (LGBT)–inclusive events on Historically Black Colleges and Universities (HBCUs); and (5) the development of a safe space for YBMSM. A multi-method approach was used to evaluate the outcomes of the different interventions. Results The majority (62%) of participants living with HIV were linked to HIV care and 49% had achieved viral suppression. More than 40% of participants were employed during the project. Thirty-seven percent (37%) of the mystery shopping tests showed definite or possible signs of housing discrimination. The housing campaign’s duration was limited with unknown long-term impact among YBMSM. Fifteen cases of syphilis were identified during two HBCU events. A safe space was specifically created for YBMSM at a community-based organization. Conclusion Multi-component holistic health interventions are needed to improve HIV outcomes and curb the high HIV rates among young Black men, particularly YBMSM in the United States and the Deep South.
... Unknown or undiagnosed HIV, engaging in condom-less anal intercourse, discrimination/homophobia, socioeconomics, and tighter sexual networks are among the established barriers to HIV prevention in this population (CDC, 2017b;Hall, Song et al., 2017;Maulsby et al., 2014). Though the HIV epidemic generally has been investigated in BMSM, limited data exists that frames how to deliver effective HIV prevention messaging and HIV testing services to this population that are both culturally competent and responsive, and that addresses the diverse behavioral, psychosocial, and structural needs of the population (CDC, 2017;Hall, Song et al., 2017;Hickson et al., 2015;Maulsby et al., 2014). There is insufficient data available that examines interactions specifically between demographics, HIV sexual risk behaviors, substance use behaviors, internalized homophobia, depression, social support, and HIV testing behaviors though many sources point to interactions of varying degrees between some of these factors (Hall, Song et al., 2017;Maulsby et al., 2014;Millett et al., 2012;Singh et al., 2014). ...
Thesis
HIV incidence among Black men who have sex with men (BMSM) is extremely high in contrast to their estimated population size and compared to other racial groups. Researchers have established that a significant proportion of these new cases annually originate from HIV transmission by BMSM who are unaware of their HIV status. The purpose of the study was to assess the relationship between age, sexual behavior, social support, substance use, internalized homophobia, depression, and HIV test history in BMSM. Guided by the social ecological model (SEM) as the conceptual framework, a quantitative cross-sectional study was designed to analyze secondary data from the HIV Prevention Trials Network Study 061. Bivariate and multivariate logistic regression was used to estimate the association. The research goal was to identify strategies to engage BMSM with infrequent/nonexistent HIV testing history into testing services. While there was very little difference between the bivariate and multivariate models, the results indicated that BMSM who were younger in age, had lower levels of internalized homophobia, and were recruited at a particular study site were more likely to have tested for HIV in the past 12 months. The other variables did not show a significant relationship to HIV testing history. Implications for positive social change included informing HIV prevention and testing messages and strategies that will result in an increase in HIV testing among BMSM with infrequent/nonexistent HIV testing histories. This increase in HIV testing among BMSM with infrequent/nonexistent HIV testing histories will reduce the number of BMSM who are unaware of their HIV status and who may subsequently transmit HIV to their sexual partners unknowingly.
... our frame to consider the multiple identities individuals hold and the social and structural contexts in which they hold these identities that shape their "environmenal riskscape." While multi-city survey studies have been conducted among Black MSM in the Deep South [43], this is the first study utilizing GPS methods to be conducted among any sample of Black MSM in the Deep South and one of few studies in the literature to implement a two-week GPS protocol [15]. To our knowledge, this is the first study to complete a two-week GPS protocol among any sample of MSM. ...
Article
Full-text available
While research increasingly studies how neighborhood contexts influence HIV among gay, bisexual and other men who have sex with men (MSM) populations, to date, no research has used global positioning system (GPS) devices, an innovative method to study spatial mobility through neighborhood contexts, i.e., the environmental riskscape, among a sample of Black MSM. The purpose of this study was to examine the feasibility of collecting two-week GPS data (as measured by a pre- and post-surveys as well as objectively measured adherence to GPS protocol) among a geographically-diverse sample of Black MSM in the Deep South: Gulfport, MS, Jackson, MS, and New Orleans LA (n = 75). GPS feasibility was demonstrated including from survey items, e.g. Black MSM reported high ratings of pre-protocol acceptability, ease of use, and low levels of wear-related concerns. Findings from this study demonstrate that using GPS methods is acceptable and feasible among Black MSM in the Deep South.
... Responding appropriately to this public health crisis requires a contextualized, thoughtful, and multi-level (i.e., intrapersonal, interpersonal, and neighborhood factors) research and prevention agenda for black MSM that is also informed by a social justice framework [4]. As a first step in setting this agenda, there is a need to fully understand the multi-level contexts that shape the HIV environmental ''riskscape'' (i.e., the set of multi-level risk and protective factors associated with HIV risk) [5] of black MSM [6,7], especially black MSM in the Deep South. Intrapersonal traits, which include resilience, are salient factors that may mitigate HIV among black MSM [8,9], but have been understudied to date. ...
Article
Full-text available
Resilience is an understudied intrapersonal factor that may reduce HIV risk among men who have sex with men (MSM). Multivariable Poisson regression models were used to estimate the prevalence ratio (PR) of sexual risk behaviors, HIV prevalence, and history of sexually transmitted infections (STIs) with resilience scores in a population-based study among 364 black MSM in the Deep South. Participants with higher resilience scores had a lower prevalence of condomless anal sex with casual sexual partners in past 12 months (PR = 0.80, p value = 0.001) and during their last sexual encounter (PR = 0.81; p value = 0.009). Resilience was inversely associated with a lower prevalence of condomless anal sex with main sexual partners, participating in a sex party/orgy and having a STI in the past 12 months. Resilience may have a protective effect on HIV among black MSM, especially in the Deep South, and should be further explored in studies with prospective designs.