Young African American men who have sex with men (AAMSM) are at greater risk of being infected with the human immunodeficiency virus (HIV) and less likely to seek HIV testing than are members of other demographic groups. This behavior results in a significant public health threat because young AAMSM with an unrecognized HIV infection are less likely to practice safer sex and, therefore, more likely to pass the infection on to their partners. This study is an examination of the social and personality factors that influence HIV testing rates among young AAMSM, using Aday's model of the social determinants of health and the Big Five model of personality as the theoretical frameworks. A cross-sectional design was employed, and social networks were used to recruit study respondents. Forty-three young AAMSM completed online questionnaires, and multiple regression techniques were used to examine relationships among the variables of interest. Statistical analysis indicated that neither the social risk factors derived from Aday's model nor the Big Five model predicted HIV testing. However, it is unknown whether these nonsignificant findings are attributable to a genuine lack of influence or the unique characteristics of the sample. Given the null results of this study and the mixed findings of prior research, further studies are required to draw conclusions regarding the influence of social and personality factors on HIV testing in this high-risk group. Additional research could be helpful in developing more effective strategies for encouraging HIV testing among young AAMSM. The potential for positive social change lies in slowing the spread of HIV through this vulnerable population and in engaging young AAMSM in the medical system to improve their long-term health prospects.

HIV-positive, Asian Pacific Islander (API) men who have sex with men (MSM) experience triple minority stigma including HIV, sexual orientation, and minority ethnicity. To date, there is no research that examines the influence of cultural factors, level of acculturation, social determinants of health, and other confounding variables (e.g., age, education, level of income, and length of time since diagnosis) on HIV-positive disclosure behaviors, attitudes, and intentions to casual sexual partners for API MSM. The theoretical framework for this study was based on Hofstede's original cultural values and Triandis's cultural dimensions. In this 2-phase, mixed methods, sequential explanatory study, 24 API MSM participants who are members of Fridae and other API organizations in the United States completed an anonymous online survey and 8 participants in Southern California completed in-depth semistructured phenomenological qualitative interviews. None of the regressions produced significant findings at the requested significance level (i.e., p < 0.5). The findings from the 2 phases of the study were integrated to facilitate a deeper, richer, and better understanding and explanation of those results than either approach alone. This mixed methods study was unique because it addressed an under-researched and poorly understood population of API MSM. The findings from this study have implications for positive social change for practitioners to incorporate culturally sensitive counseling strategies and for policymakers to develop or modify existing HIV preventive health education and health promotion programs for HIV-positive API MSM to negotiate safer sex behaviors, improve well-being, provide informed choice, and protect life that would promote competent quality care.

African-American and Latino men who have sex with men (MSM) bear a disproportionately large burden of the Human Immunodefiency Virus (HIV) epidemic in the United States. To further enhance HIV prevention efforts among men of color, a survey was conducted within New York City’s house ball community; a community largely comprised of racial and ethnic minority persons. Time-space sampling was adapted to recruit participants for the survey from venues frequented by members of the house ball community. Using logistic regression analysis, this study examined the effects of perceived stigma, enacted stigma, sense of community and self-esteem on unprotected anal intercourse (UAI) among a sub-sample of men in the survey. Both perceived and enacted stigma had a modest direct effect on engaging in UAI. The direct effect on UAI was significant even after controlling for covariates in the model. The magnitude of the effect on UAI did not vary by race/ethnicity or sexual identity. In addition, perceived and enacted stigma correlated negatively to both sense of community and self-esteem scores. Although sense of community did not buffer the effect of perceived or enacted stigma on UAI, both sense of community and self-esteem were protective against engaging in UAI. However, while the direct effect of sense of community on UAI remained after controlling for covariates in the model, the effect self-esteem had on UAI diminished after adding variables to the model. Further, self-esteem was negatively correlated with both perceived and enacted stigma, but it did not mediate perceived and enacted stigma’s effect on UAI. Implications for HIV prevention strategies given these findings are discussed. Implications include developing multilevel interventions, including structural interventions, to reduce the stigma that is perceived and experienced by men of color as well as building stronger communities for African American and Latino MSM.

International aid organizations and wealthy nations have contributed billions to combat the spread and treatment of HIV/AIDS in sub-Saharan Africa; however, these programs have been critiqued for not addressing the socioeconomic and cultural context of the epidemic, instead relying upon generalized approaches. The prevalence rate in Zanzibar, Tanzania is low in the general population, but high among vulnerable segments of Zanzibari society, resulting in interventions focusing on particular groups (e.g. sex workers, drug users, and men who have sex with men). Through interviews with government agencies, non-profit organizations, medical professionals, vulnerable populations, and HIV/AIDS patients, this paper examines how local realities inform and challenge HIV/AIDS programming in Zanzibar.

p. 1-216 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-05-08T18:01:08Z No. of bitstreams: 4 ddddddddddddddw.pdf: 366263 bytes, checksum: 214248a4bc1b1481143085bf55270bb8 (MD5) cccccccccccc.pdf: 805194 bytes, checksum: 2d485e75e2131a0e5774158a2bb3ddb6 (MD5) bbbbbbbbbbbbb.pdf: 575446 bytes, checksum: 3bec72656f3a7823fe14ccc7a732eea9 (MD5) aaaaaaaa.pdf: 612916 bytes, checksum: c1acf4fcb837d2f43c5d65c4fe309d75 (MD5) / Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-05-09T17:15:03Z (GMT) No. of bitstreams: 4 ddddddddddddddw.pdf: 366263 bytes, checksum: 214248a4bc1b1481143085bf55270bb8 (MD5) cccccccccccc.pdf: 805194 bytes, checksum: 2d485e75e2131a0e5774158a2bb3ddb6 (MD5) bbbbbbbbbbbbb.pdf: 575446 bytes, checksum: 3bec72656f3a7823fe14ccc7a732eea9 (MD5) aaaaaaaa.pdf: 612916 bytes, checksum: c1acf4fcb837d2f43c5d65c4fe309d75 (MD5) / Made available in DSpace on 2013-05-09T17:15:04Z (GMT). No. of bitstreams: 4 ddddddddddddddw.pdf: 366263 bytes, checksum: 214248a4bc1b1481143085bf55270bb8 (MD5) cccccccccccc.pdf: 805194 bytes, checksum: 2d485e75e2131a0e5774158a2bb3ddb6 (MD5) bbbbbbbbbbbbb.pdf: 575446 bytes, checksum: 3bec72656f3a7823fe14ccc7a732eea9 (MD5) aaaaaaaa.pdf: 612916 bytes, checksum: c1acf4fcb837d2f43c5d65c4fe309d75 (MD5) Previous issue date: 2008 / A prática do sexo oral e anal sem o uso do preservativo masculino é um importante fator para a infecção pelo HIV e outras DST na população dos homens que fazem sexo com homens (HSH) e das travestis. As relações entre características sociais, individuais, institucionais e as práticas sexuais desprotegidas são informações que podem ser utilizadas para estruturar ações de prevenção. Investigar as associações entre fatores de vulnerabilidade e as práticas sexuais desprotegidas além de descrever características dos HSH e travestis faz parte dos objetivos deste trabalho. O presente estudo é um recorte do Projeto Convida, inquérito sobre conhecimentos, atitudes, comportamentos e práticas de risco para a infecção pelo HIV entre HSH na cidade de Salvador na Bahia, em 2003. A população do estudo foi de HSH e travestis residentes na cidade de Salvador e região metropolitana que responderam ao questionário e que freqüentaram a “cena gay” desta cidade. A parte exploratória do estudo foi realizada com a análise de correspondência. Para a classificação da amostra em grupos, utilizou-se a análise de cluster. A modelagem estatística foi realizada utilizando regressão logística, todas norteadas pelo quadro conceitual da vulnerabilidade. A prática do sexo anal e oral desprotegido foi de 48,5% e 68,6% respectivamente, sendo a identidade sexual um importante fator para se descrever tais práticas nos grupos identificados na análise gráfica. Ajustou-se a formação dos grupos com a análise de cluster que permitiu identificar quais as características dos indivíduos que se envolvem mais freqüentemente na prática do sexo anal e oral desprotegido. A associação entre os diferentes grupos dos HSH e travestis e a prática do sexo anal desprotegido foi estatisticamente significante para o grupo dos que se sentem em médio risco de contrair HIV (OR=2,31; IC=1,68;3,19), os que se sentem em alto risco de contrair HIV (OR=1,56; IC95%=1,09;2,24), os que não responderam a percepção de risco (OR=3,20; IC95%=1,05;9,77), os ativos e passivos que gostam de todos os tipos de prática e parceria homossexual (OR=1,67 IC95%=1,07;2,61), os persuadidos/cuidadosos ao sexo desprotegido (OR=1,48; IC95%=1,16;1,89), os persuasivos e persuadidos a prática do sexo anal sem proteção (OR=6,75; IC95%=4,38;10,40). Para o sexo oral desprotegido, a associação foi estatisticamente significante para os grupos dos casados com mulher (OR=0,57; IC95%=0,38;0,87), os ativos e passivos que gostam de todos os tipos de prática e parceria homossexual (OR=3,65 IC95%=2,06;6,45), o ativo e passivo seletivo nos locais que freqüenta (OR=2,16; IC95%=1,25;3,73), o ativo sem preferência de parceiro (OR=2,34 ic95%=1,46;3,75 e os persuasivos e persuadidos a prática do sexo anal sem proteção (OR=2,41; IC95%=1,30;4,43). As práticas sexuais desprotegidas são freqüentes na população dos HSH e travestis da cidade de Salvador, sendo que os homossexuais parecem mais vulneráveis a estas práticas sexuais, seguidos das travestis. Os resultados são consistentes com alguns estudos que mostram a associação entre fatores da percepção de risco, prática do sexo insertivo sem proteção, negociação de regras para as práticas desprotegidas. Uma vantagem foi ter grupos de homens formados através da observação das relações simultâneas entre vários fatores para se observar as associações. A descrição detalhada das relações entre as práticas desprotegidas e características dos grupos de HSH e travestis podem ser usada para subsidiar ações diferenciadas e específicas de prevenção nos locais da “cena gay” de Salvador, convidando estes homens e travestis à práticas sexuais mais protegidas. / Salvador

Since the early 1990s with the AIDS pandemic, there has been an increasing interest on the importance of risky sexual behaviors, especially among men who have sex with men (MSM). An important antecedent for these behaviors is alcohol use. Studies consistently show an increased frequency of both alcohol use and risky sexual behaviors in MSM populations. However, to date, there has not been a precise estimate of the effect size in these diverse populations and a consistent way to measure it. More so, the importance of context is often cited as a source of variability, but is rarely measured in these studies. Contextual factors are different and specific for MSM, as they have been approached by two theories, both of which will be guiding this dissertation: Singer’s Syndemic Theory and Meyer’s Minority Stress Theory. Chapter 1, then presents a comprehensive review of both theories as they apply to alcohol use, risky sexual behaviors, and contextual factors driving them. Chapter 2 answers the first research question about effect sizes through a systematic literature review. The effect sizes or measures of association of these contextual risk and protective factors were summarized using meta-analytic techniques. Using five electronic databases, we identified 26 studies in 26 years (1990–2015), all diverse in terms of sampling techniques, assessment of sexual orientation, operationalization of alcohol use and risky sexual behaviors, contextual factors included, and measurement of effect sizes. Despite this diversity, studies reporting an effect size were pooled and summarized using both descriptive and meta-analytic techniques, as appropriate. Meta-analyses were conducted using Cochrane’s guidelines for generic inverse variance outcomes with random effects. The pooled effects of alcohol use on condomless anal intercourse (CAI; OR 1.73 [95% CI 1.43, 2.10], I2 0%), heavy episodic drinking on CAI (OR 1.88 [95% CI 1.25, 2.81], I2 32%), and heavy episodic drinking on condomless oral sex (OR: 8.00; 95% CI 2.48, 25.81), as well as the effects of substance use, mental health status, violence and victimization, and self-reported HIV status as contextual factors in the pathway between alcohol use and risky sexual behaviors were calculated, reported, and discussed along with study limitations and implications for public health. Chapter 3 answers the second research question regarding a standardized measurement model for effect sizes and the multiple mediation of contextual factors. We used the male subset of Wave IV of the AddHealth dataset to test our hypotheses through structural equation modeling approaches, including measurement analysis with invariance testing, path analysis for direct effects, and multiple mediation analysis through bootstrapping for indirect effects. The AUD scale was invariant between MSM and MSW, but the risky sexual behavior scale was not. For MSM, the standardized direct effect of AUD onto risky sexual behaviors was –1.25 and the standardized total indirect effect of the multiple mediation model was 1.58, 95% CI [1.42, 1.73]. Among the mediators, the strongest indirect effect for any measured or latent mediator was the mental health construct (2.09). We conclude that even though AUD has the same measurement structure for MSM and MSW, its effect on risky sexual behaviors does not operate the same way for these two populations, supporting both causal and contextual behavioral theories. Conclusions are individually discussed, respectively, in Chapters 2 and 3. However, Chapter 4 puts both manuscript conclusions in context and further discusses future implications for public health research, practice, and policy.

In 2010, men who have sex with men (MSM) represented 4% of the population in the United States (US) and accounted for 78% of all new Human Immunodeficiency Virus (HIV) infections among Hispanic men. Hispanic men who have sex with men (HMSM) accounted for the third largest number of new HIV infections (6,700 cases). This dissertation explored the effects of age, loneliness, substance use, depression, and social support on high risk sexual behaviors that predispose middle aged HMSM to sexually transmitted infections (STIs) and HIV infection risk. A sample of 150 urban HMSM aged 40 to 65 were surveyed in this study. Singer’s Syndemics Theory (1996) provided this study’s theoretical framework. Data was analyzed using a variety of parametric and non-parametric statistics. Loneliness, social support, depressive symptoms, alcohol/drug use, and sexual risk behaviors were found to have an influence on HIV infection status in this study. Partner status, religious affiliation and age did have an influence on alcohol use in this study’s participants. Also, participants with increased age had increased depressive symptoms in this study. Lastly, depressive symptoms, substance use, social support, and loneliness did have an influence on sexual risk behaviors in this study’s participants, specifically alcohol use and illicit drug use. The findings from this study should be used to assess, diagnose, plan, implement and evaluate prevention strategies geared to reduce STI and HIV infection in this population. Future research should build on these findings and develop tailored risk reduction interventions addressing HMSM, with particular attention to the understudied age group of the middle aged HMSM.

AbstractAnalysing the Impact of Stigma and Discrimination on the Linkages Across the Continuum of HIV Services for Men who have Sex with Men: A Realist ApproachBackground and Aim The world has now entered the third decade of the AIDS epidemic. Men who have sex with men (MSM) continue to be disproportionately affected by HIV/AIDS. Haiti still struggles in its response to this ongoing crisis throughout the continuum of services: disease prevention, treatment, and HIV related stigma, prejudice, and discrimination. Much of the information reported on people living with HIV has come from the general population, but only a few parts of some of those studies have focused on MSM. Therefore, the overall aim of this dissertation was to analyse the impact of stigma and discrimination on the continuum of HIV services for MSM in order to ascertain why, how and under which circumstances MSM are engaged, linked and retained along the care continuum.Methods For this dissertation, data were collected via literature review, electronic medical records, participant observations, focus groups and semi structured interviews with medical students, health care workers and MSM. Using a realist approach based on mixed methods design we sought to address the influence of HIV and sexual stigma on the continuum of HIV services and to identify key mechanisms emerging from the context and leading to the outcomes. Quantitative social and medical data were gathered and analysed to produce descriptive and analytic statistics and qualitative data were analysed thematically regarding the objectives.FindingsResults indicated that MSM experienced stigma in multiple and overlapping layers. MSM described stigmatizing experiences stemming from religious sources, communities, family and friends, and from the medical establishment. From the social construction of heteronormativity in the society, several social and cultural factors, gender norms lie behind the stigma associated with sexual orientation and HIV. Moreover, medical students and healthcare givers still carry discriminatory attitudes towards them despite tailored interventions. Our analysis showed that current service delivery models are less than optimal in linking and retaining MSM, resulting in loss to follow-up in the continuum of care and failure to fully realize the health and prevention benefits. However, multi-level, contextual-based and socially accountable interventions can produce stigma mitigation through personal, health systems’ and contextual mechanisms for better engagement, adherence and retention throughout the continuum.ConclusionsThe results within this dissertation are intended to inform health professionals in the planning and implementation of interventions for better continuum outcomes in Haiti and similar contexts. This thesis provides insight and contextual information for a socially accountable framework of adapted interventions. To end the AIDS epidemic by 2030, Haiti, the Caribbean region and the entire world urgently need to defy expectations to reach the left behind.KeywordsHIV; Continuum of HIV Services; Stigma; Discrimination; Realist Evaluation; Context-Mechanism-Outcome; Social Accountability / Doctorat en Sciences de la santé Publique / info:eu-repo/semantics/nonPublished

Sex education through the public school system has been identified by the Centers for Disease Control and Prevention as an excellent vehicle by which HIV prevention education can be presented to students, thereby decreasing the rate of HIV infection among young men who have sex with men (YMSM). However, YMSM continue to be at high risk for HIV infection in the United States despite educational efforts to prevent infection. The purpose of this qualitative study using a phenomenological approach was to explore what impact school-based HIV prevention education had on YMSM in the past, and what effect that education has had on their current sexual behaviors. The theoretical foundation for this study was the health belief model. Individual 1-hour interviews were conducted with 13 YMSM (ages 21-35) who received HIV prevention education in California. Interviews were analyzed for common themes using a phenomenological approach. Results of this study suggest that participants were not utilizing safer techniques taught in the school HIV prevention education because there was a lack of curriculum consistency, LGBTQ content, and classroom management, and the impact of stigma and homophobia on YMSM. These results support the health belief model. Findings support that positive social change can be achieved by providing standardized, all-inclusive, non-judgmental, HIV prevention education program, in a classroom environment where it is safe to receive same-sex sexual information. This should decrease the number of HIV+ test results among YMSM.

abstract: The Centers for Disease Control and Prevention (2017) note that gay, bisexual, and other men who have sex with men (collectively referred to as MSM) face more barriers to accessing health care compared to other men. Such barriers include, lack of cultural- and sexual identity-appropriate medical and support services, concerns about confidentiality, and fear of discussing sexual practices or orientation in a medical setting. In comparison to other MSM populations, Latino MSM (LMSM) report having the least amount of access to health care (McKirnan et al., 2012). The purpose of the present study is to elucidate how individual- (i.e., age, education level, and income level), community- (i.e., social support and neighborhood collective efficacy), and sociocultural-level factors (i.e., immigration status, heterosexual self-presentation, sexual identity commitment, sexual identity exploration, and ethnic identity affirmation and belonging) may relate with perceived access to healthcare. It is hypothesized that ethnic identity affirmation and belonging will moderate relations between the aforementioned predictors and perceived access to health care based on increasing evidence that ethnic identity, or one’s sense of affirmation and belonging to one’s ethnic group, may be a health protective factor. Among a sample of 469 LMSM, this study found that there were several predictors across all three levels (i.e., individual, community, and sociocultural) of perceived access to healthcare. Additionally, data supported evidence that ethnic identity affirmation and belonging (Phinney, 2003) acts as a moderator of other predictors of perceived access to healthcare in this sample. These findings can inform outreach interventions of researchers and healthcare providers about psychosocial and cultural barriers and facilitators of access to healthcare. / Dissertation/Thesis / Masters Thesis Counseling Psychology 2020