Examining the Relationship between Perceived Neighborhood Context on Sexual Risk Behaviors among Black Men who Have Sex with Men in the South

Background: The burden of HIV in the South remains disproportionate among Black MSM, who account for 48% of HIV diagnoses among MSM. Reasons for these disparities include higher-level structural and social factors, as well as psychosocial factors, that influence individual sexual risk behaviors, including neighborhood conditions, discrimination, depression, resilience, and religiosity/spirituality. The purpose of this dissertation is to examine the relationship between perceived neighborhood context and sexual risk behaviors among Black MSM in the South. Methods: The dissertation utilized data from the MARI study, which included 412 Black MSM from Jackson, MS and Atlanta, GA. The theoretical framework was based on the modified social ecological model. Statistical methods include exploratory factor analysis, bivariate and multivariable logistic regression, and simple mediation and parallel multiple mediation analyses. Results: A 4-factor solution was identified in the exploratory factor analysis, which translated to 4 domains measuring the latent construct, perceived neighborhood context: neighborhood problems, social cohesion and safety, neighborhood violence, and LGBT-friendliness. In the multivariable logistic regression analyses, social cohesion and safety was significantly associated with consistent condom use during anal sex in the past 12 months with both a main and a casual partner, consistent condom use during vaginal sex in the past 12 months, and using alcohol or drugs before or during sex. LGBT-friendliness was significantly associated with consistent condom use during anal sex in the past 12 months with a casual partner, and asking the last casual sex partner’s HIV status prior to sex. Neighborhood violence was significantly associated with exchanging sex for money. In both the simple mediation and parallel multiple mediation analyses, depression significantly mediated the relationship between 2 domains of perceived neighborhood context (i.e., social cohesion and safety, and LGBT-friendliness), and consistent condom use during anal sex in the past 12 months with a casual partner. Conclusions: Salient domains of perceived neighborhood context may be determinants of sexual risk behaviors through depression. Structural interventions are needed to improve neighborhood infrastructure to increase social cohesion and safety, reduce violence, provide an LGBT-friendly environment, and include mental health resources to reduce HIV burden among Black MSM in the South

Depression, deficits in functional capacity, and impaired glycemic control in urban African Americans with type 2 diabetes

Effective depression treatment does not reliably reduce glycosylated hemoglobin (HbA1c) in depressed patients with type 2 diabetes, possibly in part due to deficits in functional capacity, i.e. performance of certain everyday living skills, essential for effective diabetes self-management. We sought to determine: a) the magnitude of deficits in functional capacity among urban, African American (AA) patients with type 2 diabetes, and b) whether these deficits were associated with poorer glycemic control. At their initial visit to an inner-city diabetes clinic, 172 AA patients with type 2 diabetes were assessed with a variety of instruments, including the Mini International Neuropsychiatric Interview (MINI) and the UCSD Performance Skills Assessment-Brief (UPSA-B). They then entered a comprehensive diabetes management intervention, whose success was indexed by HbA1c levels at up to four reassessments over a one-year period. A mixed-effects model repeated-measures method was used to predict HbA1c. The prevalence of depression was 19%; the mean UPSA-B score was 81 ± 17. After multivariate adjustment, increased HbA1c levels over time were predicted by the presence of major depression (B = .911, p = .002) and decreasing (worse) scores on the UPSA-B (B = −.016, p = .027), respectively. Further adjustment for increasing the dosage of oral or insulin during the treatment eliminated the association between the UPSA score and HbA1c level (B = −.010, p = .115). Depression, as well as deficits in functional capacity, predicted reduced effectiveness of a diabetes self-management intervention. Future studies will determine whether interventions targeted at both improve glycemic control