Theo G M Sandfort

Theo G M Sandfort
Columbia University | CU

Ph.D.

About

279
Publications
63,883
Reads
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8,181
Citations
Citations since 2017
49 Research Items
3841 Citations
20172018201920202021202220230200400600
20172018201920202021202220230200400600
20172018201920202021202220230200400600
20172018201920202021202220230200400600
Additional affiliations
January 2012 - present
University of Amsterdam
January 2008 - present
Indiana University Bloomington
January 2004 - December 2013

Publications

Publications (279)
Article
Full-text available
We assessed pathways between sexual minority stigma and condomless anal intercourse (CAI) among two samples of Black South African men who have sex with other men (MSM). Two cross-sectional surveys were conducted in Tshwane, South Africa; one among 199 Black MSM and another among 480 Black MSM. Men reported on external and internalized experiences...
Article
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Background Black sexual minority men (SMM) ages 30 and older are under-represented in HIV studies in sub-Saharan Africa, despite being at increased risk of HIV infection and contributing to potential onward HIV transmission. To better understand the social and sexual lives of older Black South African SMM, we conducted in-depth interviews with SMM...
Article
Background: HIV-related and intersectional stigmas are key barriers for service delivery, but best practices are nascent for addressing them in high-resource and high-burden contexts such as New York City (NYC). The Stigma Reduction and Resilience (STAR) implementation science (IS) Mapping Project in 2020 identified untested stigma reduction effor...
Article
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In-depth qualitative interviews explored the experiences and understandings of men 18–39 years old who have sex with men that could facilitate or prevent HIV testing and routine HIV testing. For many men who tested frequently, testing and routine testing were motivated by awareness of the benefit of prompt treatment; public health and provider enco...
Article
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Stigma remains a pervasive barrier to Ending the HIV Epidemic (EHE) in New York City (NYC). As part of an EHE implementation science planning process, we mapped multi-level HIV-related stigma-reduction activities, assessed their evidence base, and characterized barriers and facilitators. We interviewed and surveyed a convenience sample of 27 HIV pr...
Article
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Introduction The HIV crisis in the Philippines is driven largely due to condomless sex among communities of transgender women and cisgender men who have sex with men (trans-WSM and cis-MSM, respectively). Condom use could be promoted by increasing social capital in these communities because social capital might increase one’s condom use self-effica...
Chapter
To understand the HIV epidemic among men who have sex with men in sub-Saharan Africa, it is vital to appreciate its historical, legal, and social context. While there are differences between Sub-Saharan African countries, related among other things to different experiences of colonization and decolonization, societal acceptance of same-sex sexualit...
Article
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This study evaluated short- and long-term impact of a 4-day training intervention to reduce negative perspectives of religious leaders in Kenya on sexual and gender minorities, adopting a one-group pretest-posttest-follow-up design. Religious leaders’ perspectives play an important role in maintaining the negative status quo for sexual and gender m...
Article
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Religious fundamentalism is associated with negative perceptions towards outgroups and marginalized populations. However, this association has not been studied in Africa. This study among religious leaders in Kenya established that religious fundamentalism was negatively associated with acceptance of lesbian women and gay men and acceptance of gend...
Article
Female and male sex workers are at elevated risk for HIV infection, psychological distress and other adverse health outcomes. It is therefore important to understand how sex workers' social relationships with one another might inform psychosocial support services for this population. We conducted semi-structured interviews to examine the formation...
Article
Nigerian gay, bisexual, and other men who have sex with men (GBMSM) experience social marginalisation, discrimination and violence due to their sexual orientation and same-sex attraction, which may affect mental health, substance use, and HIV sexual risk behavior. The goal of the current study was to conduct formative qualitative research to gain b...
Article
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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 ex...
Article
We explored the associations of gender expression with childhood gender expression, sexual identity, and demographic characteristics in a representative sample of the U.S. population aged 18 to 65 years (N = 1277), using data from the 2015 National Survey of Sexual Health and Behavior. As expected, gay men were less gender conforming than heterosex...
Article
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Sexually transmitted infections (STI) in lesbian and bisexual women is a relatively unexplored topic, particularly for women from low and middle-income countries. Despite perceptions that women who have sex with women (WSW) are at negligible risk for contracting STI, existing research demonstrates that WSW do become infected with STI. Given the opp...
Article
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The current study sought to identify types of group sex acts among HIV-negative men who have sex with men (MSM) and assess their association with different sexual risk behaviors using cross-sectional data of group sex acts reported during 6 waves (2015–2018) of the Amsterdam MSM Cohort Study. Latent class analysis was performed to identify group se...
Article
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Background: Risks for condomless sex among transgender women and cisgender men who have sex with men (trans-WSM and cis-MSM, respectively) in the Philippines, where HIV recently became a national public health crisis, are shaped and exacerbated by various risk factors across multiple levels. Methods: Between June 2018 and August 2019, we conduct...
Article
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Background: Gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria experience social marginalization, discrimination and violence due to their sexual identity, which may negatively impact physical, mental, and sexual health outcomes. Studies on GBMSM in Africa utilize measurement scales developed largely for populations in the Globa...
Article
Male sex workers (MSWs) and male clients (MCMs) who engage their services face increased vulnerability to violence in Kenya, where same-sex practices and sex work are criminalized. However, little is known about how violence might arise in negotiations between MSWs and MCMs. This study explored the types of victimization experienced by MSWs and MCM...
Article
This article introduces the concept of African same-sex sexualities and gender diversity which refers to variation pertinent to gender expressions and identities, sexual expression and sexual orientation. The article describes the emerging and evolving African scholarly production evident in the last two decades and explains key underlying themes t...
Preprint
Background : Gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria experience social marginalization, discrimination and violence due to their sexual identity, which may negatively impact physical, mental, and sexual health outcomes. Studies on GBMSM in Africa utilize measurement scales developed largely for populations in the Globa...
Preprint
Full-text available
Background: Gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria experience social marginalization, discrimination and violence due to their sexual identity, which may negatively impact physical, mental, and sexual health outcomes. Studies on GBMSM in Africa utilize measurement scales developed largely for populations in the Global...
Article
Full-text available
Male sex workers in Kenya face a disproportionate burden of HIV and often engage in condomless sex with their commercial partners, yet little is known about how condom negotiations between male sex workers and clients take place. We conducted semi-structured interviews with 25 male sex workers and 11 male clients of male sex workers in Mombasa, Ken...
Article
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Immigrant African gay and bisexual men (GBM) are at risk for substance use and adverse mental health outcomes due to negative experiences in home and host countries. Little is known about correlates of substance use and mental health outcomes in this population. We explored pre- and post-migratory factors associated with substance use and depressio...
Article
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Background Integration of feminizing hormone therapy (FHT) and antiretroviral therapy (ART) is critical in providing gender-affirming HIV care for transgender (trans) women living with HIV. However, interpersonal communications with HIV providers who are not competent with FHT may complicate this integration. Methods We conducted semi-structured i...
Article
Transgender women (TW) and cisgender men who have sex with men (cis-MSM) are disproportionately impacted by the national HIV crisis in the Philippines, where the HIV incidence has, in large part, been attributed to condomless sex. This study sought to qualitatively examine the socio-ecological factors that contribute to low condom uptake among Fili...
Article
Same-sex sexual attraction and gender non-conformity: The influence of parent acceptance The current study assessed, separately for boys and girls, the moderating effects of mother/father acceptance in the relationship of same-sex attraction (SSA) and gender nonconformity with psychological distress and social anxiety. Data were collected from 1,12...
Article
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Background: Alcohol use and abuse constitute a major public health problem and identifying their determinants is a priority. Social network analysis can indicate how characteristics of social networks are related to individual health behaviors. A growing number of studies have used social network analysis to examine how social network characterist...
Article
This study examined experiences with sexual violence among black African gay, bisexual, and other men who have sex with men and transgender women in townships surrounding Pretoria, South Africa. Of 81 gay, bisexual, and other men who have sex with men and transgender women interviewed, 17 reported to have experienced sexual violence perpetrated by...
Article
Full-text available
Throughout the world, men who have sex with men (MSM) are at increased risk for HIV infection compared to heterosexual men. Little is known about awareness of HIV infection and other gaps in the HIV care continuum for MSM, especially in sub-Saharan Africa (SSA). This information is urgently needed to address the HIV epidemic in this population. Thi...
Article
Due to the global burden of HIV, a better understanding of the relationship between substance use and HIV risk behavior is a public health priority, particularly among populations with high rates of HIV infection. The current study explored the moderating effects of psychosocial factors on the relationship between substance use and sexual risk beha...
Article
Among 2,185 Dutch adolescents (ages 11 to 18), we assessed whether the association among gender nonconformity, homophobic name-calling, and other general peer victimization differs for boys and girls and for youth with and without same-sex attraction (SSA). We also examined whether sex and sexual attraction differences in the association between ge...
Article
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As of 2017, the Centers for Disease Control and Prevention (CDC) HIV testing guidelines recommend that those at increased risk for HIV are tested two to four times per year. Evidence-based interventions that promote frequent and repeated testing remain sparse. We conducted a systematic review to: (1) identify frequent testing interventions; and (2)...
Article
Although South Africa protects sexual orientation in its Constitution, homosexuality is socioculturally contested and unaccepted. This lack of acceptance may impact the coming-out process of men who have sex with men (MSM). This study explored diverse factors that influenced whether Black South African MSM disclosed their sexual practices and ident...
Article
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Some HIV-infected individuals in research studies may choose not to disclose knowledge of their HIV status to study staff. We evaluated the accuracy of self-reported HIV status among African men and transgender women who have sex with men and who were screened for a research study. Sixty-seven of 183 HIV-infected participants reported a prior HIV d...
Article
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The goal of this study is to examine the relations between histories of three types of sexual orientation victimization (childhood, personal, and institutional) and HIV sexual risk behavior among Black South African men who have sex with men (MSM). Secondarily, this study examines whether marijuana use and problem drinking mediate the relations. Pa...
Article
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Unlike studies conducted in Western countries, two studies among Black South African men who have sex with men (MSM) found no support for the association between gender nonconformity and mental distress, even though gender-nonconforming men experienced more discrimination and discrimination was associated with mental distress (Cook, Sandfort, Nel,...
Article
The label “men who have sex with men” (MSM) is used to categorize a diverse population exclusively on the basis of its sexual behavior. Understanding the diversity that this label comprises is critical for the development of health interventions that effectively reach the various populations subsumed under this label. In this cross-sectional study...
Article
Full-text available
We examined why male condoms broke or slipped off during commercial sex and the actions taken in response among 75 female and male sex workers and male clients recruited from 18 bars/nightclubs in Mombasa, Kenya. Most participants (61/75, 81%) had experienced at least one breakage or slippage during commercial sex. Many breakages were attributed to...
Article
Full-text available
The experience of sexual orientation stigma (e.g., homophobic discrimination and physical aggression) generates minority stress, a chronic form of psychosocial stress. Minority stress has been shown to have a negative effect on gay and bisexual men’s (GBM’s) mental and physical health, increasing the rates of depression, suicidal ideation, and HIV...
Article
Background: There is a known heavy burden of hazardous drinking and its associated health risks among black South African MSM; however, no study to date has identified risk factors for hazardous drinking among this nor any other African MSM population. Methods: A cross-sectional survey was conducted among 480 black South African MSM recruited us...
Article
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Research studies suggest an association between substance use and sexual risk behavior, but are not completely consistent. The moderating effects of other psychosocial factors might help explain these inconsistencies. The current study therefore assessed whether substance use is associated with sexual risk behavior, and whether this relationship is...
Article
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Background: Substance use and its relation to HIV risk among men who have sex in Africa, a population at high risk for HIV, has received little attention. Methods: This systematic review summarizes and discusses findings from 68 empirical studies, published between 1980 and 2016 that included data about substance use in men who have sex with men...
Article
Pre- and post-exposure prophylaxes (PrEP and PEP) can reduce the risk of HIV acquisition, yet often are inaccessible to and underutilized by most-vulnerable populations, including sex workers in sub-Saharan Africa. Based on in-depth interviews with 21 female and 23 male HIV-negative sex workers in Mombasa, Kenya, we found that awareness and knowled...
Article
We examined correlates of sexual risk among gay and bisexual men, who recently migrated from western and eastern African countries to the USA and lived in New York City and who are HIV negative or of unknown status. These men migrate from countries where same-sex sexuality is socially rejected and mostly illegal contributing to the motivation to mi...
Article
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Religion plays an important role in framing the public discourse on sexuality, especially in countries where religion fully permeates social life. We explored the perspectives of Kenyan religious leaders on sexual and gender diversity in their country's specific context. A total of 212 Catholic, Islamic, and Protestant leaders from urban centers an...
Article
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Purpose: Intimate partner violence (IPV) research among men who have sex with men (MSM) has primarily focused on the prevalence of IPV victimization and perpetration. Although alcohol use is a known trigger of IPV in opposite sex relationships, less is known about alcohol use and IPV perpetration and victimization in same-sex couples. The aim of t...
Conference Paper
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Background: Syndemic theory has been proposed as a framework for understanding the role of multiple risk factors driving the HIV epidemic among sexual and gender minority Latinos/as. Methods: We used linear and logistic regression to assess relationships among cumulative syndemic conditions – including depression, alcohol consumption, discriminatio...
Article
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As bisexual individuals in the United States (U.S.) face significant health disparities, researchers have posited that these differences may be fueled, at least in part, by negative attitudes, prejudice, stigma, and discrimination toward bisexual individuals from heterosexual and gay/lesbian individuals. Previous studies of individual and social at...
Article
This paper explores condom use and lubrication practices among Black men who have sex with men in South African townships. Results are from 81 in-depth individual interviews conducted among a purposive sample from four townships surrounding Pretoria as part of a larger qualitative study. Awareness that condoms should be used to have safer anal sex...
Article
Gay and bisexual men in Jamaica encounter stigma and discrimination due to criminalization of and negative attitudes towards same-sex sexuality. Disclosure of sexual orientation may be self-affirming, but could increase exposure to negative responses and stressors. Outcomes of an online survey among 110 gay and bisexual Jamaican men ages 18 to 56 y...
Article
We assessed among a sample of 724 Dutch lesbian, gay, and bisexual-identified adults (Mage = 31.42) whether experiences with homophobic stigmatization and internalized homophobia simultaneously mediated the relation of gender nonconformity with mental health. Results indicated that homophobic stigmatization and internalized homophobia partially med...
Article
There is considerable diversity, fluidity and complexity in the expressions of sexuality and gender among men who have sex with men (MSM). Some non-gay identified MSM are known colloquially by gay-identified men in Mpumalanga, Province, South Africa, as 'After-Nines' because they do not identify as gay and present as straight during the day but als...
Article
Background: Group sex has been suggested as a potential high-risk setting for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM). We investigated whether group sex is associated with lower condom use during anal sex and higher proportions of STIs compared with dyadic sex among HIV-negative MSM between 2009 a...
Conference Paper
Full-text available
Background: One in five Latino men who have sex with men (MSM) have experienced child sexual abuse (CSA). Although concerning in itself, CSA may increase individuals' likelihood of depression and risk-taking in adult life, including engagement in behaviors associated with increased HIV risk. It is therefore urgent that researchers and practitioners...
Article
Purpose: To describe sexual and reproductive health characteristics of women who have sex with women (WSW) in Kenya's three most populous cities: Kisumu, Mombasa, and Nairobi. Although the last decade has shown an upsurge of health-related research studies in African sexual minority populations, these studies have generally concentrated on the hea...
Article
Full-text available
Experiences of forced sex have been shown to be prevalent in Southern Africa. Negative outcomes of forced sex have been documented in general populations of women and men and include alcohol abuse, drug use, mental health problems, mental distress, sexual health problems and poor overall health. This study is the first to examine experiences of for...
Article
Full-text available
Purpose: Sexual orientation has been shown to be a risk factor for psychiatric disorders. This study compared whether sexual orientation-related disparities in the prevalence of psychiatric disorders are similar based on homosexual behavior versus attraction and tested whether, with increased acceptance of homosexuality, these disparities have dim...
Conference Paper
Understanding the individual and structural factors that make Latino MSM vulnerable to poor health care and social services seeking behaviors is essential especially in the context of the Affordable Care Act. This study provides characteristics and assesses the correlates of health care and social services utilization among this group. Data collect...
Article
The current study assessed, separately for boys and girls, the moderating effects of mother/father acceptance in the relationship of same-sex attraction (SSA) and gender nonconformity (GNC) with psychological distress and social anxiety. Data were collected from 1,121 secondary school students (539 boys and 582 girls; Mage = 16.6) by means of a pap...
Article
Sexual minority youth were found to be more likely to drink alcohol during weekdays compared to heterosexual youth. Drinking during weekdays was associated with consuming alcohol as a coping strategy. Sexual minority youth also more frequently consumed alcohol to eliminate personal worries (coping) and to not be excluded by their peers (conformity)...
Article
Full-text available
One barrier to wider preexposure prophylaxis (PrEP) availability is uncertainty about the most appropriate providers and practice settings for offering PrEP. The authors conducted in-depth interviews with 30 clinicians-primary care and HIV specialists-in the New York City (NYC) region to explore issues related to PrEP rollout, including who should...
Article
Full-text available
Background The aim of this study was to compare clinical expressions (severity and loneliness), lifestyle factors (substance use), and vulnerability indicators (stressful childhood experiences) in patients with any same-sex attraction versus heterosexual patients diagnosed with depression and/or anxiety disorder. Little is known about this, even th...
Article
We assessed whether homophobic name-calling accounts for the relationship between gender nonconformity and mental health (social anxiety and psychological distress) in a sample of 1,026 Dutch adolescents (boys: n = 517) ages 11 to 16 (Mage = 13.4). We also explored whether this hypothesized mediation differs by sexual attraction and biological sex....
Article
Using data from a study about HIV risk among Black South African MSM, we aimed to ascertain whether unexpected findings about the relationship between gender nonconformity, discrimination, and mental health in this population, as reported by Cook, Sandfort, Nel, and Rich (2013), could be replicated, and to explore more in-depth how gender nonconfor...
Article
Samenvatting Het huidige onderzoek bekeek of structurele elementen van schoolklimaat een positieve samenhang kunnen hebben met het psychisch welbevinden van seksuele minderheidsleerlingen. Hierbij werden de psychische problemen van seksuele minderheidsleerlingen vergeleken met seksuele meerderheidsleerlingen. In het bijzonder werd gekeken naar de r...
Article
Although teachers may be in a position to address enactments of sexual and gender stigma among their students, little is known about their motivations to intervene in such situations. We surveyed secondary school teachers in the Netherlands, assessing how beliefs, norms, and self-efficacy were related to their intentions to intervene in two hypothe...
Article
Full-text available
To investigate site-specific condom-use norms as assumed by visitors of gay venues and websites across The Netherlands and their association with men's own use of condoms. In 2010, men who have sex with men (MSM) visiting 18 sex venues (e.g., saunas), 30 nonsex venues (e.g., bars), 6 dating websites, and 2 social network websites completed an on-si...
Article
To explore demographic, behavioral and psychosocial risk factors for HIV infection in South African MSM we recruited 480 MSM (aged 18 and 44 years) using respondent-driven sampling. Data were collected through individual computer-assisted face-to-face interviews. Participants were tested for HIV. RDS-adjusted HIV prevalence is 30.1 % (unadjusted 35...
Article
Full-text available
Predominantly Spanish-speaking Latino men who have sex with men (MSM) and their same-sex partners continue to be at high risk for HIV and STIs. Behavioral research has identified how relationship dynamics for male couples are associated with sexual risk behavior. Connect 'n Unite (CNU), an evidence-based HIV/STI prevention intervention originally c...
Article
Transactional sex has not been studied much among men who have sex with men in Africa. Consequently, little is understood about attitudes towards the practice, the circumstances that give rise to it or how transactional sex relationships are managed. We conducted in-depth interviews with 81 Black men aged 20-44 from four low-resourced townships in...
Article
Same-sex attraction and gender nonconformity have both been shown to negatively affect the relationships of adolescents with their peers. It is not clear, though, whether same-sex attracted adolescents are more likely to have negative peer relationships because they are same-sex attracted or because they are more likely to be gender nonconforming....