In December 2021, long-acting injectable pre-exposure prophylaxis (LAI-PrEP) was approved for the prevention of HIV in at-risk adults and adolescents. LAI-PrEP may address adherence issues of daily ...oral daily PrEP and PrEP stigma. However, studies assessing LAI-PrEP willingness among PrEP naive Black and Hispanic sexual and gender minority (SGM) persons– a group disproportionately impacted by the HIV epidemic in the United States – is rare. To assess the extent of and characteristics of willingness to use LAI-PrEP in a national sample of Black and Hispanic SGM who are self-reported that they have
never
used PrEP. We analyzed data from a national sample of Black and Hispanic SGM collected between March and August 2020. We used log-binomial regression models to assess characteristics associated with willingness to use LAI-PrEP. Of the overall sample (
N
= 380), the mean age was 24 (SD = 2.8) and the majority of the sample (54%,
n
= 205) reported willingness to use LAI-PrEP. In multivariable log-binomial regression models, PrEP stigma was independently associated with less prevalence ratio (PR) = 0.7, 95% confidence interval (CI) = 0.6, 0.9, while number of sexual partners in the past 12 months was associated with a more willingness to use LAI-PrEP (PR = 1.1, 95% CI = 1.0, 1.2). Our findings highlight the persistence of PrEP stigma as a potential barrier to willingness to use LAI-PrEP in this sample of Black and Hispanic SGM who have never used PrEP. Additional work needs to be done to reduce PrEP stigma more broadly.
Many persons living with HIV (PLWH) either reduced their employment capacity or stopped work completely due to disease progression. With the advent of effective antiretroviral therapy, some PLWH were ...able to return to the workforce and many are now transitioning into retirement. We examined the histories of employment, retirement and disability status on depression among 1,497 Participants living with HIV from 1997 to 2015 in the Multicenter AIDS Cohort Study. Data were collected on depressive symptoms, employment, retirement, disability status as well as HIV-related and sociodemographic characteristics. Employment, retirement and disability status were lagged 2 years to assess whether the risk of depression at a given observation were temporally predicted by each respective status, adjusting for prior depressive symptoms and covariates. Being employed (aOR: 0.76; 95% CI: 0.71-0.82) had lower odds of depression risk two years later compared to those unemployed. There were higher odds of depression risk associated with disability (aOR: 1.43; 95% CI: 1.32-1.54) versus those not on disability. Retirement status was not associated with the risk of depressive symptoms. These findings could help inform policies and employment programs to facilitate the return to work for PLWH who are willing and able to work.
Among millions of people who suffer from schistosomiasis in China, adolescents are at increased risk to be infected. However, there is a lack of theory-guided behavioral prevention intervention ...programs to protect these adolescents. This study attempted to apply the Protection Motivation Theory (PMT) in predicting intentions to engage in protective behaviors against schistosomiasis infection.
The participants were selected using the stratified cluster sampling method. Survey data were collected using anonymous self-reported questionnaire. The advanced structural equation modeling (SEM) method was utilized to assess the complex relationship among schistosomiasis knowledge, previous risk exposure and protective measures in predicting intentions to engage in protective behavior through the PMT constructs.
Approximately 70% of participants reported they were always aware of schistosomiasis before exposure to water with endemic schistosomiasis, 6% of the participants reported frequency of weekly or monthly prior exposure to snail-conditioned water. 74% of participants reported having always engaged in protective behaviors in the past three months. Approximately 7% were unlikely or very unlikely to avoid contact with snail-conditioned water, and to use protective behaviors before exposure. Results from SEM analysis indicated that both schistosomiasis knowledge and prior exposure to schistosomiasis were indirectly related to behavior intentions through intrinsic rewards and self-efficacy; prior protective behaviors were indirectly related to behavior intentions through severity, intrinsic rewards and self-efficacy, while awareness had an indirect relationship with behavior intentions through self-efficacy. Among the seven PMT constructs, severity, intrinsic rewards and self-efficacy were significantly associated with behavior intentions.
The PMT can be used to predict the intention to engage in protective behaviors against schistosomiasis. Schistosomiasis intervention programs should focus on the severity, intrinsic rewards and self-efficacy of protection motivation, and also increase the awareness of infection, and enrich the contents of schistosomiasis education.
•Use of e-cigarettes is increasing in the United States.•Little is known on the impact of e-cigarettes on cardiometabolic risk.•E-cigarette's use was associated with increased odds of high blood ...pressure.•E-cigarette had no significant difference in abnormal serum lipid levels.
To determine the association between cigarette use (i.e., never-use – reference group, exclusive e-cigarette users, exclusive cigarette smoking, and dual use of both products) with cardiometabolic risk biomarkers.
Data came from two cycles (2015–2016 and 2017–2018) of the National Health and Nutrition Examination Survey. We used weighted logistic regression models to determine the association of cigarette use and reduced high-density lipoprotein cholesterol (HDL-C; <40 mg/dL, for men and <50 mg/dL for women), elevated low-density lipoprotein cholesterol (LDL-C; ≥130 mg/dL), elevated triglycerides (TG; ≥150 mg/dL), elevated fasting blood glucose (FBG; (≥100 mg/dL), and high blood pressure (HBP; Systolic ≥130 mm Hg/Diastolic ≥85 mm Hg).
Of the 8688 adults 18+ years of age included, 2.7%, 3.2%, and 14.9% self-reported exclusive e-cigarette, dual use, and exclusive cigarette smoking respectively. After adjusting for covariates, exclusive e-cigarette use was significantly associated with increased odds of HBP (adjusted odds ratio aOR = 2.05, 95% confidence interval CI = 1.03, 4.08). Dual use was associated with increased odds of reduced HDL-C (aOR = 1.64, 95% CI = 1.01, 2.70). Exclusive cigarette smoking was significantly associated with reduced HDL-C (aOR=1.80, 95% CI=1.45, 2.23) and elevated TG (aOR = 1.59, 95% CI = 1.01, 2.52).
Results are preliminary and warrant replication from larger samples with longitudinal follow-up.
We assessed socio-structural and behavioral correlates of preexposure prophylaxis (PrEP) for HIV infection among a sample of high-risk HIV-negative men who have sex with men (MSM) in Los Angeles, ...California. Participants from an ongoing 5-year prospective cohort study investigating the direct impacts of substance use on HIV transmission dynamics were enrolled between February 2015 and January 2017. All men completed a computer-assisted self-interview every 6 months that assessed recent (past 6 months) PrEP use and socio-structural and behavioral factors. Of the total 185 MSM (mean age = 29 years) included in the study, majority were African American (40%) or Hispanic (41%) and reported current health insurance coverage (80%). In multivariable analysis using log-binomial regression, having health insurance coverage adjusted prevalence ratio (aPR) 2.02; 95% confidence interval (CI) 1.01 to 4.01,
p
= 0.04 was associated with recent PrEP use. Unstable housing (aPR = 0.44, 95% CI 0.22 to 0.90,
p
= 0.02) was associated with lower PrEP use. Behavioral factors associated with recent PrEP use include sex with a HIV-positive partner (aPR = 3.63, 95% CI 1.45 to 9.10,
p
= 0.01), having six or more sex partners (aPR = 2.20, 95% CI 1.26 to 3.82,
p
= <0.01), and popper use (aPR = 2.76, 95% CI 1.58 to 4.84,
p
= <0.01). In this sample of predominantly racial/ethnic minority MSM, socio-structural and behavioral factors were important factors associated with recent PrEP use. These findings provide considerations for intervention development to promote PrEP use among key groups of MSM.
BACKGROUND:Pre-exposure prophylaxis (PrEP) is efficacious for HIV prevention. Black men who have sex with men (MSM) accounted for the largest proportion of new HIV diagnoses in the United States ...relative to other racial/ethnic groups. Black MSM who use substances are at an increased risk for HIV infection and are ideal candidates for PrEP, but barriers to maintaining PrEP adherence remain a concern. We assessed whether substance use behaviors are associated with initiation and adherence to PrEP among a sample of black MSM in the United States.
METHODS:Data for this analysis come from the HIV Prevention Trails Network Study 073 (HPTN 073). Substance use behaviors—including alcohol, marijuana, poppers (ie, alkyl nitrites), and stimulants (ie, methamphetamine/cocaine use) including use of these substances before/during condomless anal intercourse (CAI)—were assessed longitudinally through self-report. PrEP adherence was assessed by pharmacological testing in blood. Generalized estimating equations were used to evaluate association between substance use behaviors and PrEP initiation and adherence.
RESULTS:Among 226 HIV-negative black MSM, the majority (60%) were 25+ years of age. Most of the substance use behaviors were not significantly associated with PrEP initiation or adherence. However, stimulant use before/during CAI was significantly associated with lower odds of PrEP adherence (adjusted odds ratio = 0.21, 95% confidence interval = 0.07 to 0.61; P = <0.01).
CONCLUSIONS:These findings suggest that PrEP adherence is feasible among black MSM who use substances. However, black MSM who engage in stimulant use before/during CAI may present a unique group for additional study and support with enhanced behavioral health and support services.
Violence against women remains a significant public health problem globally. The majority of longitudinal studies documenting the negative impact of intimate partner violence (IPV) on the mental ...health of women come from high-income countries. The aim of this study was to investigate the longitudinal association between emotional, physical, or sexual IPV and depression symptoms among South African women in a prospective cohort study. Participants were 981 South African women enrolled in the Drakenstein Child Health Study—a cohort study investigating the early life determinants of child health. Interview data from four time-points (antenatal care visit, 6 months, 12 months, and 18 months postpartum) were included. The primary independent variable was self-reported emotional, physical, and sexual IPV in the past 12 months. Depressive symptoms were assessed at each time-point with the Edinburgh Postnatal Depression Scale (EPDS); a cutoff score of ⩾13 was used to define significant depression symptoms. We used pooled-multivariable logistic regression models to determine associations between the three different forms of IPV and significant depression symptoms while adjusting for time-fixed and time-updated covariates. The mean age of the sample at antenatal care visit was 27 years (standard deviation = 6.0). In the adjusted model including all forms of IPV and adjusting for sociodemographic and clinical characteristics, substance use, and childhood trauma, emotional (adjusted odds ratio aOR =1.55, 95% confidence interval (CI): 1.02, 2.34; p = .039) and sexual (aOR = 2.02, 95% CI: 1.10, 3.72; p < .001) IPV were significantly associated with significant depression symptoms. The relationship between physical IPV and significant depression symptoms was not statistically significant (aOR = 0.68, 95% CI: 0.44, 1.05; p = .485). Our study confirms findings from high-income countries of the association between IPV and depressive symptoms among women in South Africa. Routine screening for IPV, including emotional IPV and intervention programs for IPV among women, is needed in South Africa.
Young men in South Africa experience several adverse socio-structural and psychosocial factors that may contribute HIV risk behaviors. This study applied a syndemic framework to explore whether these ...syndemic factors are interconnected and work in synergy to increase HIV risk behaviors. Five syndemic factors were assessed including: binge drinking, polydrug use, depressive symptoms, violence and food insecurity on two HIV risk behaviors: multiple sex partners and transactional sex. Participants were (N = 1233) young men aged 18–29 years from a township in Cape Town, South Africa. Bivariate logistic regression analysis demonstrated that many of the syndemic factors were related to one another. Pairwise interactions (on an additive scale) among the syndemic factors revealed significant positive interactions between binge drinking and violence on greater odds of reporting multiple sex partners (
aOR
= 5.10, 95%
CI
3.10, 8.29;
p
= < .001) compared to reporting neither factor. Also, food insecurity and violence (
aOR
= 2.89, 95%
CI
1.63, 5.11;
p
= < .001) as well as food insecurity and polydrug use (
aOR
= 2.73, 95%
CI
1.54, 4.84;
p
= < .001) were significantly associated with greater odds of transactional sex compared to reporting neither factor. Our findings highlight a synergistic relationship between some adverse socio-structural and psychosocial factors on HIV risk behaviors. HIV prevention programs that address multiple syndemic factors simultaneously may achieve greater impact on HIV risk reduction.
Among sexual minority men (SMM), internalized homophobia (IH) has been consistently associated with increased depression symptoms. However, some SMM experiencing IH demonstrate resilience to buffer ...against depression symptoms. In this analysis, we used the Stress Process Model (SPM) as a conceptual framework to explore individual-level psychosocial resilience (ILPR) factors serving as a buffer of the IH–depression relationship. To utilize the SPM to explore whether four ILPR factors, including volunteerism, optimism, religiosity/spirituality, and global resiliency measure mediate the relationship between IH and depression symptoms among middle-aged and older SMM living with and without HIV. We used exploratory and confirmatory factor analysis to construct measurement models for the four ILPR factors. We examined whether the four ILPR factors mediated the IH–depression relationship. IH was significantly and positively associated with depression symptoms. There was a partial mediation of the IH–depression association by the four ILPR. Specifically, we found statistically significant indirect effects of optimism and the global resilience measure and supporting buffering effects of the IH–depression association. Although, the indirect effects religiosity/spirituality on the IH–depression relationship was significant, it did not support a buffering of effect. The indirect effects of volunteerism were not statistically significant. Our findings highlight the potential role of ILPR factors in the development of resilience against the negative effects of IH. Implications of these results for future research and practice are discussed.
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