Mental health and support among young key populations: an ecological approach to understanding and intervention

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138222/1/jia29429.pd

Racialized Sexual Discrimination (RSD) in the Age of Online Sexual Networking: Are Young Black Gay/Bisexual Men (YBGBM) at Elevated Risk for Adverse Psychological Health?

Young Black gay/bisexual men (YBGBM) are a highly marginalized population across multiple health outcomes. Most research on YBGBM health has focused on HIV/sexual health, but there is a demonstrable need for research examining racism and psychosocial functioning among this population. Racialized Sexual Discrimination (RSD), also known as sexual racism, is an important but under‐investigated phenomenon that may have implications for the psychological health and well‐being of YBGBM. This paper provides an overview of empirical research on RSD as experienced by gay/bisexual men of color in online partner‐seeking venues. First, the researchers discuss how racialized experiences are a documented online phenomenon, with a variety of manifestations, and identify the potential effects that this phenomenon may have on the psychosocial health of YBGBM, and gay/bisexual men of color as a whole. Second, the researchers synthesize the RSD literature with a broader literature examining psychological well‐being across race and sexual orientation. Third, the researchers present a theoretically grounded conceptual model detailing the pathways between RSD and psychological well‐being using a stress and coping framework. The paper concludes with recommendations for future research on this topic, including scale development and hypothesis testing.HighlightsRacialized Sexual Discrimination (RSD) is a multidimensional yet understudied construct.RSD, also known as sexual racism, is widely perpetuated in online hook‐up websites for gay men.RSD may negatively impact the psychological health of gay/bisexual men of color.There is an imperative to develop robust measurement tools to capture the full extent of RSD.A conceptual and analytic model to guide scientific inquiry into RSD is proposed.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155883/1/ajcp12401.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155883/2/ajcp12401_am.pd

Stigma Reduction in Adolescents and Young Adults Newly Diagnosed with HIV: Findings from the Project ACCEPT Intervention

This article describes the influence of a group-based behavioral intervention for adolescents and young adults newly diagnosed with HIV (Project ACCEPT) on four dimensions of HIV-related stigma?personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes about people with HIV?as measured by the Berger HIV Stigma Scale. Stigma was addressed in a holistic manner during the intervention by providing HIV/AIDS-related information, facilitating the acquisition of coping skills, and providing contact with other youth living with HIV in order to improve social support. Fifty youth (28 male, 22 female; mean age=19.24 years) newly diagnosed with HIV from four geographically diverse clinics participated in a one-group pretest-posttest design study whereby they received the intervention over a 12-week period, and completed assessments at baseline, post-intervention, and 3-month follow-up. Results from the combined sample (males and females) revealed overall reductions in stigma in three dimensions: personalized stigma, disclosure concerns, and negative self-image, although only the combined-sample effects for negative self-image were maintained at 3-month follow-up. Gender-specific analyses revealed that the intervention reduced stigma for males across all four dimensions of stigma, with all effects being maintained to some degree at the 3-month follow-up. Only personalized stigma demonstrated a decrease for females, although this effect was not maintained at the 3-month follow-up; while the other three types of stigma increased at post-intervention and 3-month follow-up. Findings are discussed in terms of gender specific outcomes and the need for a different type of intervention to reduce stigma for young women.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140165/1/apc.2013.0331.pd

State‐Level Transgender‐Specific Policies, Race/Ethnicity, and Use of Medical Gender Affirmation Services among Transgender and Other Gender‐Diverse People in the United States

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162794/2/milq12467.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162794/1/milq12467_am.pd

Resilience Processes Demonstrated by Young Gay and Bisexual Men Living with HIV: Implications for Intervention

Given the increasing numbers of young gay/bisexual men (YGBM) diagnosed with HIV, it is important to understand the resilience processes enacted by this population in order to develop interventions that support their healthy development. Qualitative interviews were conducted with 54 YGBM (ages 17 to 24; 57% African American, 22% Latino) living with HIV from four geographically diverse clinics in the United States. Resilience processes clustered into four primary thematic areas: (1) engaging in health-promoting cognitive processes; (2) enacting healthy behavioral practices; (3) enlisting social support from others; and (4) empowering other young gay/bisexual men. These data suggest that YGBM living with HIV demonstrate resilience across multiple dimensions, including intrapersonal-level resilience related to individual cognitions and behaviors, as well as interpersonal-level resilience related to seeking support and providing support to others. Implications for the development of culturally-appropriate and strengths-based secondary prevention and other psychosocial interventions for YGBM living with HIV are discussed.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140154/1/apc.2013.0330.pd

Psychological Symptoms Among 2032 Youth Living with HIV: A Multisite Study

This study determined the prevalence and patterns of psychological symptoms in adolescents and young adults living with HIV (YLWH) in medical care and relationships between psychological symptoms, route and duration of infection, and antiretroviral treatment (ART). A clinic-based sample of 2032 YLWH (mean age 20.3 years), recruited from 20 adolescent medicine HIV clinics, completed a cross-sectional survey of health behaviors and psychological symptoms using the Brief Symptom Inventory (BSI). Overall, 17.5% of youth reported psychological symptoms greater than the normative threshold on the Global Severity Index. A wide variety of symptoms were reported. The prevalence of clinical symptoms was significantly greater in youth with behaviorally acquired HIV compared to those with perinatally acquired infection (20.6% vs. 10.8%, OR=2.06 in Multiple Logistic Regression (MLR)), and in those not taking ART that had been prescribed (29. 2% vs. 18.8%, OR=1.68 in MLR). Knowing one's HIV status for more than one year and disclosure of HIV status were not associated with fewer symptoms. A large proportion of YLWH have psychological symptoms and the prevalence is greatest among those with behaviorally acquired infection. The high rate of psychological symptoms for youth not taking ART that is prescribed is a cause for concern. Symptoms do not appear to be a transient reaction to diagnosis of HIV.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140176/1/apc.2014.0113.pd

Psychosocial Influences on Engagement in Care Among HIV-Positive Young Black Gay/Bisexual and Other Men Who Have Sex with Men

Young black gay/bisexual and other men who have sex with men (YB-GBMSM) living with HIV are at risk for poor engagement in HIV care. Relatively little is known about factors that impact engagement outcomes at various stages along the HIV care continuum in this specific population. The purpose of this analysis was to examine associations between various psychosocial factors and likelihood of engagement at each stage of the care continuum, among a geographically diverse sample of 132 YB-GBMSM living with HIV. Negative self-image, a component of HIV stigma, had an inverse association with early care seeking after HIV diagnosis (OR=1.05; 95% CI 1.01?1.10). Negative self-image was also inversely associated with adherence to medical appointments (OR=0.95; 95% CI 0.91?0.99), while employment (OR=0.30; 95% CI 0.12?0.75) and ethnic identity affirmation (OR=0.28; 95% CI 0.12?0.68) were both positively associated with appointment adherence. HIV-positive identity salience was associated with a higher likelihood of being on antiretroviral therapy (OR=1.06; 95% CI 1.02, 1.09). These findings highlight the importance of processes related to identity development, as both barriers and facilitators of engagement in care for HIV-positive YB-GBMSM.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140188/1/apc.2014.0117.pd

EVOLUTION—Taking Charge and Growing Stronger: The Design, Acceptability, and Feasibility of a Secondary Prevention Empowerment Intervention for Young Women Living with HIV

In the United States, youth of 13?24 years account for nearly a quarter of all new HIV infections, with almost 1000 young men and women being infected per month. Young women account for 20% of those new infections. This article describes the design, feasibility, and acceptability of a secondary prevention empowerment intervention for young women living with HIV entitled EVOLUTION: Young Women Taking Charge and Growing Stronger. The nine session intervention aimed to reduce secondary transmission by enhancing social and behavioral skills and knowledge pertaining to young women's physical, social, emotional, and sexual well-being, while addressing the moderating factors such as sexual inequality and power imbalances. Process evaluation data suggest that EVOLUTION is a highly acceptable and feasible intervention for young women living with HIV. Participants reported enjoying both the structure and comprehensive nature of the intervention. Both participants and interventionists reported that the intervention was highly relevant to the lives of young women living with HIV since it not only provided opportunities for them to broaden their knowledge and risk reduction skills in HIV, but it also addressed important areas that impact their daily lives such as stressors, relationships, and their emotional and social well-being. Thus, this study demonstrates that providing a gender-specific, comprehensive group-based empowerment intervention for young women living with HIV appears to be both feasible and acceptable.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140143/1/apc.2013.0085.pd