Baseline Clinical Characteristics, Antiretroviral Therapy Use, and Viral Load Suppression among HIV-Positive Young Men of Color Who Have Sex with Men

Given the continued high incidence of HIV infection in the United States among racial/ethnic minority young men who have sex with men (YMSM), and an appreciation that antiretroviral therapy (ART) can provide personal and public health benefits, attention is needed to enhance the detection of HIV-infected youth and engage them in medical care and support services that encourage sustained HIV treatment and suppression of viremia. Poor retention in clinical care has been associated with higher mortality, an increase in HIV RNA, and decreased CD4 cell count. 

The goal of the current study was to evaluate the health care utilization and health outcomes of HIV-infected racial/ethnic minority YMSM enrolled in an outreach, linkage, and retention study funded by the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB). We hypothesized that among racial/ethnic minority YMSM, baseline CD4 counts and usage of ART are influenced by age, race, drug and alcohol use, and mental health symptoms. 

Overall, 155 subjects had at least a baseline CD4 count recorded at study entry. There was a low rate of ART use in this population with only one-half of the cohort with CD4 counts ≤350 cells/mm³ being prescribed ART to treat their infection. However, of those youth who were started on ART, the majority (74%) did achieve undetectable viral loads (<400 copies). 

Given the continued increase in cases of HIV infection among racial/ethnic minority YMSM, efforts to increase both the provision of ART and support services that encourage adherence in this population are warranted.

Full article at:   http://goo.gl/WVmIZm

By:  Lisa B. Hightow-Weidman, M.D., M.P.H.,1 Karen Jones, M.S.,2 Gregory Phillips, II, M.S.,2 Amy Wohl, Ph.D.,3 andThomas P. Giordano, M.D., M.P.H.4, for The YMSM of Color SPNS Initiative Study Group

¹University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.

²The George Washington University School of Public Health and Health Services, Washington, District of Columbia.

³Los Angeles County Department of Public Health, Los Angeles, California.

⁴Baylor College of Medicine and the Thomas Street Health Center, Houston, Texas.

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The use of vouchers in HIV prevention, referral treatment, and care for young MSM and young transgender people in Dhaka, Bangladesh: Experience from ‘HIM’ initiative

Introduction

The study described the effectiveness of a voucher scheme to access sexual and reproductive health and HIV services among young MSM and transgender people aged 15–24 years in Dhaka, Bangladesh, a country with HIV prevalence of less than 0.1%.

Methods

Descriptive and analytical methods were used to assess the net effects of biodemographic factors of the respondents on the voucher scheme. Effectiveness of the scheme was contextualized as target population coverage, and turnaround time of voucher redemption to access services.

Results and discussion

A total of 210 (87.9%) out of the 239 vouchers distributed were redeemed. The mean age of the identified young people was 19.6 years (SD = +2.6 years). The coverage of the scheme against the target population of 200 young MSM and 936 young transgender people was 88% (n = 175) and 4% (n = 35) respectively, with P < 0.001. The median turnaround time for voucher redemption was 7 days. The predictors of voucher turnaround time were age, education, and population group (P < 0.001). HIV testing and counselling was accessed by 160 (76%) respondents, one was positive and linked to antiretroviral treatment and 110 (52%) were diagnosed and treated for sexually transmitted infections.

Conclusion

The voucher scheme was effective in linking young MSM with sexual and reproductive health and HIV services in Dhaka, Bangladesh. The findings are consistent with the low HIV prevalence in the country. The scheme is, however, not optimal for linking young transgender people with services.

Below:  Distribution of turnaround time for voucher redemption to access sexual and reproductive health and HIV services among respondents

Predictors of voucher turnaround time among young MSM and transgenders in Dhaka, Bangladesh

Social Characteristics	Within 7 days		Within 14 days
	Odds ratio exp β (95% CI)	P value	Odds ratio exp β (95% CI)	P value
Age
20–24 years (rc)
15–19 years	0.37 (0.20–0.67)	0.001	0.33 (0.17–0.64)	0.001
Highest education level
None/primary education (rc)
Secondary education	0.42 (0.17–1.04)	0.059	0.44 (0.16–1.19)	0.105
Postsecondary education	0.34 (0.12–0.99)	0.047	0.20 (0.06–0.65)	0.008
Population group
Young MSM (rc)
Young transgender people	0.18 (0.03–0.97)	0.047	0.44 (0.09–2.04)	0.291
Occupation
Nonstudents (rc)
Students	1.16 (0.50–2.71)	0.732	1.85 (0.73–4.66)	0.196
Location of social network
Areas within and around tertiary institutions (rc)
Open parks and recreation centres	0.82 (0.39–1.73)	0.606	0.89 (0.39–2.01)	0.777
Municipal areas	2.64 (0.40–17.38)	0.313	0.53 (0.90–3.09)	0.477
Resource centres	0.67 (0.22–2.07)	0.483	0.42 (0.13–1.37)	0.152
Constant	5.24 (1.83–15.00)	0.002	12.05 (3.57–40.73)	0.00
Total number of cases	210		210
Model χ2 (df = 8)	21.47		21.85
Model significance (P value)	0.006		0.0052
log likelihood	−134.588		−122.041

CI, confidence interval; rc, reference category.

Full article at:  http://goo.gl/pWRV2T

By:  Tajudeen O. Oyewale,a,† Shale Ahmed,b Farid Ahmed,f Mona Tazreen,f,∗ Ziya Uddin,c,† Anisur Rahman,d and Kola A. Oyedirane,‡

^aHIV Section, United Nations Children's Fund, New York City, New York, USA

^bBandhu Social Welfare Society

^cHIV Programme, United Nations Children's Fund

^dNational AIDS/STD Programme, Ministry of Health and Family Welfare, Dhaka, Bangladesh

^eJohn Snow Inc., Arlington, Virginia, USA

^fHIV Programme, UNICEF Bangladesh, Dhaka, Bangladesh

Correspondence to Tajudeen O. Oyewale, MBBS, MPH, PhD, UNICEF House, 3 UN Plaza, New York 10017, NY, USA. Tel: +1 212 326 7567; 

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Socioeconomic Disconnection as a Risk Factor for Increased HIV Infection in Young Men Who Have Sex with Men

PURPOSE:

HIV disproportionately affects young men who have sex with men (YMSM), particularly black YMSM. Increasingly, researchers are turning to social, economic, and structural factors to explain these disproportionate rates. In this study, we explore the relationship between socioeconomic disconnection and HIV status and factors related to HIV infection, including drug use, condomless anal sex, and binge drinking. We operationalize socioeconomic disconnection in this young population as lack of engagement in educational and employment opportunities.

METHODS:

Baseline data were analyzed from a longitudinal cohort study of YMSM aged 16-20 years recruited from the Chicago area (N = 450). Bivariate analyses of the association of socioeconomic disconnection and HIV-positive status, drug and alcohol use, and condomless anal sex were assessed using chi-square tests. The relationship of socioeconomic disconnection and HIV-positive status was then examined in multivariate logistic regression models, controlling for age and race/ethnicity and significant behavioral factors.

RESULTS:

Among study participants, 112 (25%) were not in school, 310 (69%) were not currently working, and 81 (18%) were neither in school nor working. Black MSM were more likely to be socioeconomically disconnected (neither in school nor working; n = 56, 23.3%). The results revealed that disconnected YMSM were more likely to binge drink (AOR = 2.34; 95% CI = 1.16, 4.74) and be HIV positive (AOR = 2.24; 95% CI = 1.04, 4.83). Subpopulation analysis for black participants revealed similar associations (AOR of binge drinking = 2.92; 95% CI = 1.07, 8.01; AOR of HIV positive = 2.38; 95% CI = 1.03, 5.51). Controlling for substance use, the association between disconnection and HIV-positive status remained significant (AOR = 2.37; 95% CI = 1.08, 5.20).

CONCLUSION:

Socioeconomic disconnection is significantly and positively associated with HIV status among YMSM, suggesting that the two factors are related. Socioeconomic factors present an important area for future research focusing on HIV infection in this high-risk group.

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By:  Gayles TA1, Kuhns LM1, Kwon S1, Mustanski B2, Garofalo R1.

• 1 Division of Adolescent Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University , Chicago, Illinois.
• 2 IMPACT Program, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University , Chicago, Illinois. 
• LGBT Health. 2016 Mar 22. 

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Psychological Well-Being among Religious and Spiritual-identified Young Gay and Bisexual Men

Religiosity and spirituality are often integral facets of human development. Young gay and bisexual men (YGBM), however, may find themselves at odds when attempting to reconcile potentially conflicting identities like religion and their sexual orientation. 

We sought to explore how different components of religiosity (participation, commitment, spiritual coping) are linked to different markers of psychological well-being (life purpose, self-esteem, and internalized homophobia). 

Using data collected in Metro Detroit (N = 351 ages 18-29 years; 47 % African American, 29 % Non-Latino White, 8 % Latino, 16 % Other Race), we examined how components of religiosity/spirituality were associated with psychological well-being among religious/spiritual-identified participants. 

An overwhelming majority (79.5 %) identified as religious/spiritual, with most YGBM (91.0 %) reporting spirituality as a coping source. Over three quarters of our religious/spiritual sample (77.7 %) reported attending a religious service in the past year. Religious participation and commitment were negatively associated with psychological well-being. 

Conversely, spiritual coping was positively associated with YGBM’s psychological well-being. Programs assisting YGBM navigate multiple/conflicting identities through sexuality-affirming resources may aid improve of their psychological well-being. 

We discuss the public health potential of increasing sensitivity to the religious/spiritual needs of YGBM across social service organizations.

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By:  

Steven Meanley

, Emily S. Pingel

, José A. Bauermeister 

University of Michigan School of Public Health

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Predictors of Human Papillomavirus Vaccination among Young Men Who Have Sex with Men

BACKGROUND:

Human papillomavirus (HPV) is a common sexually transmitted infection that causes anal, penile, and oropharyngeal cancers in men. Men who have sex with men (MSM) are at particularly high risk for HPV infection and HPV-related disease. Human papillomavirus vaccination is currently recommended for all MSM in the United States through age 26 years, yet little is known about HPV vaccine uptake in this population. The purpose of this study was to identify predictors of HPV vaccine uptake and barriers and facilitators to HPV vaccination that may be unique to young MSM.

METHODS:

Men aged 18 to 26 years (n = 336) were recruited via advertisements placed on a geospatial smartphone dating application designed for MSM. Participants completed an online survey. Correlates of vaccine uptake and provider recommendation for HPV vaccine were identified using logistic regression.

RESULTS:

In total, 21% of participants had received at least 1 dose of HPV vaccine. Provider recommendation was the strongest predictor of uptake such that MSM with a recommendation were more than 40 times more likely to have been vaccinated. Additional predictors of uptake included age and HPV vaccine attitudes. Predictors of provider recommendation included sexual identity, race/ethnicity, condomless anal sex, and HIV status. Psychosocial correlates and barriers and facilitators to HPV vaccination among unvaccinated men were also identified.

CONCLUSIONS:

Findings highlight potential disparities in HPV vaccine uptake, as well as disparities in provider recommendation practices for HPV vaccination. Future interventions should aim to clarify misconceptions, modify psychosocial beliefs, and address barriers and facilitators to HPV vaccine uptake specific to young MSM.

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By:  Gerend MA1, Madkins K, Phillips G 2nd, Mustanski B.

• 1From the *Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; and †Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL. 
• Sex Transm Dis. 2016 Mar;43(3):185-91. doi: 10.1097/OLQ.0000000000000408.

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Intimate Partner Violence and Sex among Young Men Who Have Sex With Men

PURPOSE:

Among young men who have sex with men (YMSM) few studies have examined the relationship between intimate partner violence (IPV) perpetration versus victimization and sexual behaviors.

METHODS:

Using data from n = 528 urban YMSM, multinomial logistic regression models were built to examine the distinct relationships between any IPV, victimization, and perpetration with condomless sex in the previous 30 days, controlling for key sociodemographic characteristics.

RESULTS:

In this sample of YMSM, lifetime experience of any IPV was associated with increased odds of recent condomless oral and anal receptive sex. IPV victimization was associated with a greater likelihood of condomless receptive anal sex whereas IPV perpetration was associated with increased odds of condomless receptive and insertive anal sex.

CONCLUSIONS:

Among YMSM, reports of both IPV perpetration and victimization were associated with increased odds of recent condomless sex. These findings indicate that the need for IPV prevention and intervention programs for this new generation of YMSM is highly warranted.

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By:  Stults CB1, Javdani S2, Greenbaum CA2, Kapadia F3, Halkitis PN4.

• 1Center for Health, Identity, Behavior and Prevention Studies (http://steinhardt.nyu.edu/appsych/chibps), The Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York; Department of Applied Psychology, The Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York.
• 2Department of Applied Psychology, The Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York.
• 3Center for Health, Identity, Behavior and Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York; Global Institute of Public Health, New York University, New York, New York; Department of Population Health, Langone School of Medicine, New York University, New York, New York.
• 4Center for Health, Identity, Behavior and Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York; Department of Applied Psychology, The Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York; Global Institute of Public Health, New York University, New York, New York; Department of Population Health, Langone School of Medicine, New York University, New York, New York. Electronic address: perry.halkitis@nyu.edu. 

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HIV-Related Stigma and HIV Prevention Uptake among Young Men Who Have Sex with Men and Transgender Women in Thailand

HIV-related stigma is a pervasive structural driver of HIV. With an HIV epidemic among young men who have sex with men (MSM) and transgender women (TG) in Thailand characterized as explosive, we conducted a cross-sectional survey among MSM and TG aged 18-30 years. 

From April-August 2013, participants recruited using venue-based sampling from gay entertainment sites and community-based organizations completed a tablet-assisted survey interview in Thai language. We conducted multiple logistic regression to assess correlations between HIV-related stigma (felt-normative, vicarious domains) and socio-demographic variables, HIV vulnerabilities (gay entertainment employment, sex work, forced sex history), and HIV prevention uptake (condom use, HIV testing, rectal microbicide acceptability). 

Among participants (n = 408), 54% identified as gay, 25% transgender, and 21% heterosexual. Two-thirds (65.7%) were employed at gay entertainment venues, 67.0% had more than three male partners (past month), 55.6% had been paid for sex, and 4.5% were HIV-positive. One-fifth (21.3%) reported forced sex. Most participants reported experiencing felt-normative and vicarious HIV-related stigma. 

Adjusting for socio-demographics, participants with higher total HIV-related stigma scores had significantly lower odds of HIV testing and rectal microbicide acceptability, and higher odds of having experienced forced sex. Both vicarious and felt-normative dimensions of HIV-related stigma were inversely associated with HIV testing and rectal microbicide acceptability. 

Our findings suggest that HIV-related stigma harms the health of HIV-negative MSM and TG at high risk for HIV infection. HIV-related interventions and research among young MSM and TG in Thailand should address multiple dimensions of HIV-related stigma as a correlate of risk and a barrier to accessing prevention.

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By:  Logie CH1, Newman PA1, Weaver J1, Roungkraphon S2, Tepjan S1.

• 1 Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada .
• 2 Faculty of Science and Technology, Rajamangala University of Technology Phra Nakhon , Bangkok, Thailand .

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Incidence of HIV infection and Sexually Transmitted Infections and Related Risk Factors among Very Young Men Who Have Sex with Men

INTRODUCTION:

The HIV epidemic continues to disproportionately affect men who have sex with men (MSM) in the US, with over a third of new infections in MSM occurring in younger men. Very few studies have reported on HIV and STI incidence and related risks among younger MSM, particularly among minors under 18 years of age.

METHODS:

Data analyzed herein are from a longitudinal study of HIV-risk among 450 very young MSM in Chicago ages 16-20, recruited via respondent-driven sampling and followed for two years, with annual HIV and STI testing. We report estimated cumulative HIV and STI incidence over the 24-month follow-up using Kaplan-Meier methods and evaluated associations with incident infections using Cox Proportional Hazards regression.

RESULTS:

The final analytic sample was primarily non-White (83%); median age was 19; 25% of the sample was under age 18. 26 new HIV infections were detected over 632 person-years of follow-up. HIV incidence was 4.11/100 person years (95% CI=2.80-6.04) and STI incidence was 6.22/100 person-years (95% CI=4.54-8.51). Cumulative HIV incidence over 24 months of follow-up was 7.32% (95% CI= 5.05-10.57), with higher incidence among racial/ethnic minorities. In multivariate analyses, non-White race and recent sexual partner concurrency were associated with both HIV and STI infection; HIV testing history and sex with an HIV-positive partner were associated with increased risk of HIV infection.

DISCUSSION:

High rates of incident HIV infection and STIs among very young MSM and the relationship between incidence and race/ethnicity, concurrency and partner characteristics indicate potential focal points of future intervention and the need for continued vigilance.

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By:  Garofalo R1, Hotton AL, Kuhns LM, Gratzer B, Mustanski B.

• 1Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. USA2Northwestern University, Feinberg School of Medicine, Department of Pediatrics, Chicago, IL. USA3Division of Infectious Diseases, John H. Stroger Hospital4Howard Brown Health Center, Chicago, IL5Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, IL USA. 
• J Acquir Immune Defic Syndr. 2016 Jan 7.

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Characterizing Body Image in Youth with HIV

Emerging research in adults with HIV suggests negative body image may be found at a higher rate in this group. To date, few studies have examined body image in adolescents living with HIV. 

This exploratory study aimed to characterize body image perceptions among youth living with HIV. Adolescents (n = 143; age range 16-24 years; 69 % male) completed an Audio Computer Assisted Self-Interview Questionnaire that assessed body image, psychosocial, medical and sociodemographic information. Medical history and physical functioning information were abstracted from medical records. 

Results showed normative global body image on the Multidimensional Body Self-Relations Questionnaire-Appearance Scales. Some subscale elevations were observed; including decreased interest in self-care and appearance, as well as concerns with individual body areas. 

Overall, youth reported preference for own body shape on the Figure Rating Scale; however, 41 % of youth classified as "overweight" per CDC body mass index reported contentment with current body size. Further, 47 % of youth classified as "normal" weight desired to have larger body size. 

Youth identified as men who have sex with men most often reported desiring larger body size. Implications for clinical care are discussed.

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By:   Wilkins ML1,2, Dallas RH3, Porter JS4, Tang L5, Sun Y5, Magdovitz-Frankfurt P4, Gaur AH3.

• 1Department of Infectious Diseases, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mailstop 600, Memphis, TN, 38105, USA. megan.wilkins@stjude.org.
• 2Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA. megan.wilkins@stjude.org.
• 3Department of Infectious Diseases, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mailstop 600, Memphis, TN, 38105, USA.
• 4Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
• 5Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA. 
• AIDS Behav. 2015 Dec 31

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"I provide the pleasure, I control it": Sexual Pleasure & "Bottom" Identity Constructs amongst Gay Youth in a Stepping Stones Workshop

This paper explores the meanings attached to gay sexuality through the self-labelling practices of a group of young gay-identified students in focus group and individual interviews in Johannesburg, South Africa. These meanings include constructs of the dynamics surrounding safe sex negotiation and risk related to "top-bottom" subject positioning as well as the erotics of power and desire that are imbued in these practices and positioning. 

Using performativity theory as a theoretical tool of analysis, I argue that constructs of "top-bottom" subjectivities can be seen to meet certain erotic needs for LGBTI youth, including reasons related to physical safety for LGBTI people living in dangerous spaces. The performance of "bottom" identities in sexual intimacy and behaviour is further deployed in the expression and performance of power that the participants construct as erotic. 

The implications for sexual health intervention include understanding the gendered performance influences of sexual behaviour including safe sex, exploring creative ways that practices of sexual health can be engaged with this population group in a way that accommodates the erotic pleasure interfaced with sexual identity identifications and performances of "bottom" identities.

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By:   Kiguwa P¹.

¹Senior Lecturer, Department of Psychology, University of the Witwatersrand, South Africa. Electronic address: Peace.Kiguwa@wits.ac.za.

Reprod Health Matters. 2015 Nov;23(46):117-26. doi: 10.1016/j.rhm.2015.11.016. Epub 2015 Dec 17. 

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