Transgender women are disproportionately incarcerated in the US relative to the general population. A dearth of research has explored the factors that predict incarceration among transgender women or ...the longitudinal impact of incarceration on the health of this population.
Between 2012 and 2015, 221 transgender women ages 16-29 from Boston, MA and Chicago, IL were prospectively assessed at baseline, 4, 8 and 12 months. Mixed effects models were used to identify risk factors for incarceration and examine whether incarceration predicts somatic, anxiety and depressive symptoms, illicit drug use, and binge drinking over time, controlling for baseline psychiatric and substance use disorders.
Overall, 38% experienced incarceration, before (33%) and during (18%) the study period. Significant independent predictors of recent incarceration included sex work, recent homelessness, school dropout and number of times incarcerated prior to enrollment while recent incarceration significantly predicted somatic symptoms and illicit drug use over time.
Incarceration burden is high in young transgender women. Both structural and individual risk factors predict incarceration and poor health, suggesting the need for multilevel interventions to prevent incarceration and support young transgender women during incarceration and upon release.
•Affiliation networks are integrated with molecular data to examine HIV transmission.•Core-peripheral structure in venue affiliation is associated with HIV transmission.•Popular social venues ...potentiate sexual affiliation network of minority young MSM.•Molecular and affiliation network approach informs effective network interventions.•A surveillance-research-community partnership is important to address ethical issues.
This study investigates the two-mode core-periphery structures of venue affiliation networks of younger Black men who have sex with men (YBMSM). The study examined the association between these structures and HIV phylogenetic clusters, defined as members who share highly similar HIV strains that are regarded as a proxy for sexual affiliation networks. Using data from 114 YBMSM who are living with HIV in two large U.S. cities, our findings indicate that HIV phylogenetic clustering patterns were found to be associated with social clustering patterns whose members share affiliation with core venues that overlap with those of YBMSM. Distinct HIV transmission patterns were found in each city, a finding that can help to inform tailored venue-based and network intervention strategies.
Evidence suggests that respondent-driven sampling (RDS) is an efficient approach to sampling among varied populations of adult men who have sex with men (MSM) both in the USA and abroad, although no ...studies have yet evaluated its performance among younger MSM, a population with a steep rise in HIV infection in recent years. Young MSM (YMSM) may differ in terms of their connectedness to other YMSM (e.g., due to evolving sexual identity, internalization of sexual minority stigma, and lack of disclosure to others) and mobility (e.g., due to parental monitoring) which may inhibit the sampling process. The aims of this study were to evaluate the efficiency and effectiveness of RDS-based sampling among young urban MSM and to identify factors associated with recruitment success. We hypothesized that demographic, social, behavioral, and network factors, including racial/ethnic minority status, homelessness (i.e., as an indicator of socioeconomic marginalization), HIV-positive status, substance use problems, gay community connectedness, and network size would be positively related to recruitment productivity, while sexual minority stigmatization, environmental barriers (e.g., parental monitoring), and meeting sex partners on the internet (i.e., virtual venue) would be negatively related to recruitment productivity. Between December 2009 and February 2013, we used RDS to recruit a sample of 450 YMSM, ages 16–20. Findings suggest that the use of RDS for sampling among YMSM is challenging and may not be feasible based on the slow pace of recruitment and low recruitment productivity. A large number of seeds (38 % of the sample,
n
= 172) had to be added to the sample to maintain a reasonable pace of recruitment, which makes use of the sample for RDS-based population estimates questionable. In addition, the prevalence of short recruitment chains and segmentation in patterns of recruitment by race/ethnicity further hamper the network recruitment process. Thus, RDS was not particularly efficient in terms of the rate of recruitment or effective in generating a representative sample. Hypotheses regarding factors associated with recruitment success were supported for network size and internalized stigma (but not other factors), suggesting that participants with larger network sizes or high levels of internalized stigma may have more and less success recruiting others, respectively.
Background
Young Black women between the ages of 18 and 24 years are disproportionately impacted by HIV, yet they have a low self-perception of HIV risk and limited exposure to prevention strategies. ...Pre-exposure prophylaxis (PrEP) is a safe and effective biomedical HIV prevention strategy for those at risk for HIV infection, but uptake has been slow among cisgender women. Family planning clinics are a primary source of health care access for young women, providing an ideal opportunity to integrate PrEP information and care into existing clinic practices.
Objective
The aim of this study was to use a multistage, community-engaged process to develop a mobile health app and to evaluate the feasibility and acceptability of the app.
Methods
Using user-centered design, the In the Loop app was developed in collaboration with a community advisory board of young Black women. This study employed a multistage design, which included community-engaged app development, user testing, and evaluation of the app’s feasibility and acceptability. A pre- and postdesign was used to assess the impact of the app on PrEP knowledge immediately after app use. Descriptive statistics (eg, mean, SD, and percentage values) were used to describe the sample, and Wilcoxon matched-pairs signed-ranks test was used to detect changes in PrEP knowledge before and immediately after using the app.
Results
A total of 50 sexually active, young Black women, aged 18-24 (mean 21, SD 1.9) years, were enrolled in this study. Analysis comparing scores before and immediately after use of the app revealed a significant increase in PrEP content knowledge scores on a 7-item true or false scale (z=–6.04, P<.001). Overall, participants considered the In the Loop app feasible and acceptable to use while waiting for a family planning visit. The majority of participants (n=46, 92%) agreed that they would recommend In the Loop to friends to learn more about PrEP. Participants rated the overall quality of the app 4.3 on a 1-5 scale (1=very poor and 5=very good). Of 50 participants, 40 (80%) agreed that the app was easy to use, and 48 (96%) agreed that they found the information in the app easy to understand. Finally, 40 (80%) agreed that they had enjoyed using the app while waiting for their family planning visit.
Conclusions
Our findings suggest that young Black women waiting for family planning visits found the In the Loop app to be feasible and acceptable. This study demonstrates the value of engaging young Black women in the app design process. As family planning clinics are a primary source of health care access for young women, they provide an ideal setting to integrate PrEP information and care into existing clinic practices. Next steps in the development of the In the Loop app include implementing user-suggested improvements and conducting efficacy testing in a randomized controlled trial to determine the app’s impact on PrEP uptake.
Young transgender women are at increased risk for HIV infection due to factors related to stigma/marginalization and participation in risky sexual behaviors. To date, no HIV prevention interventions ...have been developed or proven successful with young transgender women. To address this gap, we developed and pilot tested a homegrown intervention “Life Skills,” addressing the unique HIV prevention needs of young transgender women aged 16–24 years. Study aims included assessing the feasibility of a small group-based intervention with the study population and examining participant’s engagement in HIV-related risk behaviors pre- and 3-months-post-intervention. Fifty-one (
N
= 51) young transgender women enrolled in the study. Our overall attendance and retention rates demonstrate that small group-based HIV prevention programs for young transgender women are both feasible and acceptable. Trends in outcome measures suggest that participation in the intervention may reduce HIV-related risk behaviors. Further testing of the intervention with a control group is warranted.
Abstract Young men who have sex with men (MSM) are a risk group highly vulnerable to HIV infection and psychiatric symptoms are direct predictors of sexual risk behavior in MSM. Childhood sexual ...abuse (CSA) is associated with psychiatric symptomology in adolescence, and MSM are disproportionately impacted by CSA compared to heterosexuals. Some evidence suggests that childhood gender nonconformity, a natural variation of human gender expression, is more common in MSM than heterosexual males and places MSM at greater risk for CSA. This study examined whether or not childhood gender expression moderated the association between incidents of unwanted, early sexual experiences occurring before age 13 (ESE) and current psychiatric symptomology in a community-based sample of 449 young MSM aged 16–20. Analyses revealed significant bivariate associations between ESE and psychological symptoms, and significant multivariable associations between ESE, gender nonconformity and psychiatric outcomes. Young MSM with childhood gender nonconformity may be disproportionately victimized by CSA thereby increasing their likelihood of developing psychiatric symptoms in adolescence. Early intervention addressing these factors may help reduce lifetime negative sequelae.
Despite the approval of PrEP for adolescents by the FDA in 2018, little is known about the awareness and attitudes about PrEP use among adolescent sexual minority males, who are at the greatest risk ...for HIV. We analyzed baseline data from the MyPEEPS Mobile study, a multi-site randomized controlled trial evaluating the effectiveness of a mobile behavioral HIV prevention intervention. A substantial proportion (68.2%) of study participants (ages 13–18) had previously heard about PrEP, and an overwhelming majority (90.8%) reported willingness to take PrEP, to prevent HIV. On the other hand, only about one third (34.6%) of participants indicated that taking a daily HIV pill would be “very” or “completely” effective in preventing HIV when having sex without a condom. These findings suggest that high awareness and willingness to use PrEP across various adolescent subgroups present opportunities for increased PrEP advocacy among this young age group.
Background To generate unbiased estimates for data collected using respondent-driven sampling (RDS), a number of assumptions need to be met: individuals recruit randomly from their social network and ...people can accurately report their eligible network size. However, research has shown that these assumptions are often violated. Methods This study used baseline data from Crew 450, a longitudinal study of young men who have sex with men in Chicago who were recruited via a modified form of RDS and its network substudy, in which a subset of 175 participants reported details on the composition and characteristics of their social network at either 1 or 2 years postbaseline. Results Nearly two-thirds of participants reported giving coupons to at least one alter (64%), and 56.3% believed their alter(s) used the coupons. Frequency of communication, closeness and type of relationship played a major role in determining coupon distribution. Participants whose alters used coupons were significantly less likely to describe the strength of their relationship as ‘not at all close’ (OR=0.08; 95% CI 0.02 to 0.36) compared with ‘very close’ and to communicate weekly (OR=0.20; 95% CI 0.08 to 0.49) or 1–6 times in the past 6 months (OR=0.18; 95% CI 0.06 to 0.59). Conclusions Contrary to RDS assumptions, we found that relationship characteristics played a significant role when individuals decided to whom they would give coupons.
Transgender men and transmasculine youth are at high risk for acquiring HIV. Growing research on transgender men demonstrates increased HIV risk and burden compared with the general US population. ...Despite biomedical advancements in HIV prevention, there remains a dearth of evidence-based, sexual health HIV prevention interventions for young transgender men. MyPEEPS (Male Youth Pursuing Empowerment, Education, and Prevention around Sexuality) Mobile is a web-based app that builds on extensive formative community-informed work to develop an evidence-based HIV prevention intervention. Our study team developed and tested the MyPEEPS Mobile intervention for 13- to 18-year-old cisgender young men in a national randomized controlled trial, which demonstrated efficacy to reduce sexual risk in the short term-at 3-month follow-up. Trans men and transmasculine youth resonated with basic HIV educational information and sexual scenarios of the original MyPEEPS app for cisgender men, but recognized the app's lack of transmasculine specificity.
The purpose of this study is to detail the user-centered design methods to adapt, improve the user interface, and enhance the usability of the MyPEEPS Mobile app for young transgender men and transmasculine youth.
The MyPEEPS Mobile app for young transgender men was adapted through a user-centered design approach, which included an iterative review of the adapted prototype by expert advisors and a youth advisory board. The app was then evaluated through a rigorous usability evaluation.
MyPEEPS Mobile is among the first mobile health interventions developed to meet the specific needs of young transgender men and transmasculine youth to reduce HIV risk behaviors. While many of the activities in the original MyPEEPS Mobile were rigorously developed and tested, there was a need to adapt our intervention to meet the specific needs and risk factors among young transgender men and transmasculine youth. The findings from this study describe the adaptation of these activities through feedback from a youth advisory board and expert advisors. Following adaptation of the content, the app underwent a rigorous usability assessment through an evaluation with experts in human-computer interaction (n=5) and targeted end users (n=20).
Usability and adaptation findings demonstrate that the MyPEEPS Mobile app is highly usable and perceived as potentially useful for targeting HIV risk behaviors in young transgender men and transmasculine youth.
Despite recent reductions, youth substance use continues to be a concern in the United States. Structured primary care substance use screening among adolescents is recommended, but not widely ...implemented. The purpose of this study was to describe the distribution and characteristics of adolescent substance use screening in outpatient clinics in a large academic medical center and assess related factors (i.e., patient age, race/ethnicity, gender, and insurance type) to inform and improve the quality of substance use screening in practice.
We abstracted a random sample of 127 records of patients aged 12-17 and coded clinical notes (e.g., converted open-ended notes to discrete values) to describe screening cases and related characteristics (e.g., which substances screened, how screened). We then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and used multiple logistic regression to identify related factors.
Among 127 records, rates of screening by providers were 72% (each) for common substances (alcohol, marijuana, tobacco). The primary method of screening was use of clinical mnemonic cues rather than standardized screening tools. A total of 6% of patients reported substance use during screening. Older age and racial/ethnic minority status were associated with provider screening in multiple logistic regression models.
Despite recommendations, low rates of structured screening in primary care persist. Failure to use a standardized screening tool may contribute to low screening rates and biased screening. These findings may be used to inform implementation of standardized and structured screening in the clinical environment.
not applicable.
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