LIVING WITH TRAUMA: A MULTIMETHOD STUDY OF POSTTRAUMATIC STRESS, HIV RISK, & RESILIENCE AMONG CISGENDER SEXUAL MINORITY MEN IN THE UNITED STATES

Background Cisgender sexual minority men (SMM) in the United States (US) are disproportionately burdened by trauma and posttraumatic stress disorder (PTSD). Limited but growing research has linked PTSD symptoms to sexual risk behaviors among SMM but minimally accounted for PTSD symptomology’s heterogeneity. Moreover, resilience processes in response to trauma remain poorly understood and understudied among SMM. This dissertation aimed to identify latent classes of posttraumatic stress symptoms, assess associations between class membership and serodiscordant condomless anal sex, and explore trauma’s impact and associated resilience processes among SMM. Methods Trauma-exposed SMM’s responses (6,319/11,069) to a PTSD symptom scale in the American Men’s Internet Survey were subjected to latent class analysis; latent classes were then regressed on sociodemographic and other variables. In a subsample of non-Hispanic Black and white SMM (N=4,286), associations between latent classes and serodiscordant condomless anal sex were determined via the manual three-step Bolck, Croon, and Hagenaars method; moderation by race and social cohesion was also examined. An interpretative phenomenological analysis (IPA) approach with multiple in-depth interviews and photo/image-elicitation was used to explore trauma’s impact and resilience processes among Black SMM (N=9). Results Four latent classes of posttraumatic stress symptoms emerged: “Intrusive-Avoidant”; “Dysphoric-Inattentive”; “Pervasive”; and “Resistant.” Relative to white participants, non-Hispanic Black participants were overrepresented in the Intrusive-Avoidant class. Relative to HIV-negative participants, those living with HIV were overrepresented in the Pervasive class. Higher prevalence of serodiscordant condomless anal sex was associated with Pervasive and Dysphoric-Inattentive class membership relative to Resistant class membership, as was higher prevalence of serodiscordant condomless anal sex with a high-risk partner. There were no significant moderation effects. Black SMM perceived trauma as transformative, experiencing a sense of depletion/disconnection, encumbrance/fixation, and pain/turmoil. Participants overcame trauma’s impact via resilience processes involving purpose-giving/meaning-making, restoring self-worth/belief in goodness in the world, and reconstituting/cultivating self. Conclusions Posttraumatic stress symptoms emerge in diverse patterns among trauma-exposed SMM in the US, necessitating nuanced assessment and intervention approaches. As patterns are differentially linked to HIV transmission risk behaviors, integrated trauma-focused, sexual risk-reduction interventions tailored to each pattern may be warranted. Engaging Black SMM and leveraging their inherent resilience may improve psychosocial wellness

Publisher Correction To: Disclosure of same-sex practices and experiences of healthcare stigma among cisgender men who have sex with men in five sub-Saharan African countries

An amendment to this paper has been published and can be accessed via the original article

Disclosure of same-sex practices and experiences of healthcare stigma among cisgender men who have sex with men in five sub-Saharan African countries

Background For men who have sex with men (MSM) across sub-Saharan Africa (SSA), disclosure of same-sex practices to family and healthcare workers (HCWs) can facilitate access to HIV prevention services and support, but can also lead to experiences of stigma. Methods We performed mixed-effects regressions on pooled data from MSM in Cameroon, Senegal, Côte d’Ivoire, Lesotho, and eSwatini to assess associations between disclosure and sexual behavior stigma in healthcare contexts; we used logistic regressions to analyze country-specific data. Results Compared to participants who had not disclosed to either family or HCWs, those who had disclosed only to family were more likely to have been gossiped about by HCWs (aOR = 1.70, CI = 1.18, 2.45); the association between having disclosed to family and having felt mistreated in a health center approached, but did not achieve, statistical significance (aOR = 1.56, CI = 0.94, 2.59). Those who had disclosed only to HCWs were more likely to have feared to seek health services (aOR = 1.60, CI = 1.14, 2.25), avoided health services (aOR = 1.74, CI = 1.22, 2.50), and felt mistreated in a health center (aOR = 2.62, CI = 1.43, 4.81). Those who had disclosed to both were more likely to have feared to seek health services (aOR = 1.71, CI = 1.16, 2.52), avoided health services (aOR = 1.59, CI = 1.04, 2.42), been gossiped about by HCWs (aOR = 3.78, CI = 2.38, 5.99), and felt mistreated in a health center (aOR = 3.39, CI = 1.86, 6.20). Country-specific analyses suggested that data from Cameroon drove several of these associations. Conclusions Research to determine the factors driving disclosure’s differential effect on healthcare stigma across contexts is needed. Ultimately, supportive environments enabling safe disclosure is critical to understanding HIV-acquisition risks and informing differentiated HIV-prevention, treatment, and testing services for MSM across SSA

Tibetan Refugees in Dharamsala, India: A Mini-Ethnography

Special Studies Experience -- Dharamsala, India -- Summer 2015 -- Partner Agencies: LHA Charitable Trust, Institute for Social Work & Educationhttp://deepblue.lib.umich.edu/bitstream/2027.42/116193/1/Poster_Wiginton.pd

‘We can act different from what we used to’: Findings from experiences of religious leader participants in an HIV-prevention intervention in Zambia

Faith-based organisations (FBOs) have long been part of the fight against HIV and AIDS. International bodies continue to collaborate with FBOs to implement HIV-prevention programmes with mixed success. Zambia has been a target of such programmes in part due to its high HIV prevalence. The Trusted Messenger approach to provide religious leader networks with biomedical, science-focused education about HIV and AIDS was piloted in 2006, but participant experiences of the intervention have not been explored qualitatively. In 2016, in-depth interviews were conducted of 34 randomly chosen individuals who attended Trusted Messenger workshops between 2006 and 2016 in Livingstone, Lusaka, and the Copperbelt region. Findings indicate that the religious leader attendees gained scientific insights about HIV which motivated their action in personal, social, and religious contexts. Participants found the science comprehensible and empowering and identified workshop frequency and language as challenging. Utilising science-focused education within contextual settings of religious leader networks can combat the spread of HIV and the mistreatment of people living with HIV and AIDS

Hearing from men living with HIV: Experiences with HIV testing, treatment, and viral load suppression in four high-prevalence countries in sub-Saharan Africa

Engaging men in HIV services remains a challenge across sub-Saharan Africa. There is a critical need to better understand facilitators of men\u27s successful engagement with HIV services and assess if there are similarities across contexts. We conducted in-depth interviews and focus group discussions with 92 men living with HIV (MLHIV) across Malawi, Uganda, South Africa, and Eswatini, most of whom had been diagnosed with HIV within the last 5 years. We coded interviews for themes using a constant-comparative approach. We contextualized our findings within a socioecological framework. HIV testing was primarily motivated by illness (individual level), though illness was sometimes accompanied by prompting and support from healthcare providers and/or intimate partners. Once diagnosed, nearly all participants reported immediate linkage to care, initiation of antiretroviral therapy (ART), and subsequent ART adherence. ART initiation and adherence were facilitated by men\u27s sense of agency and ownership over their health (individual level), social support from intimate partners, friends, and family (interpersonal/network level), supportive-directive counseling from healthcare providers (institutional/health systems level), and male-friendly services, i.e., rapid, respectful, private (institutional/health systems level). Health literacy regarding viral suppression (individual level), strengthened by patient-provider communication (institutional/health systems level), was highest in Uganda, where most men could discuss viral load testing experiences, report their viral load status (most reported suppressed), and demonstrate an understanding of treatment as prevention. Elsewhere, few participants understood what viral load suppression was and even fewer knew their viral load status. Our findings reveal socioecological-level facilitators of men\u27s progress across the HIV-care continuum. Programs may want to leverage facilitators of ART initiation and adherence that span socioecological levels—e.g., healthcare ownership and agency, social support, supportive-directive counseling—and apply them to each end of the continuum to encourage early HIV testing/diagnosis and improve health literacy to help men understand and achieve viral load suppression