Supporting LGBTQ+ Survivors on Campus

Back by popular demand, last year\u27s Supporting LGBTQ+ Survivors on Campus has been revamped for the new state of Title IX. Historically, Title IX protections have provided a much-needed resource for addressing sexual violence on campus. However, the benefits of Title IX may not apply equally to all students in practice. This workshop will discuss how the history of Title IX raises questions about its applicability for all sexual violence, and ultimately explore strategies for addressing sexual violence in lesbian, gay, bisexual, trans, and queer (LGBTQ+) communities. How effectively does Title IX address same-sex violence? What other policy and programmatic options exist? How can we improve support for LGBTQ+ students? Attendees will learn a framework for analyzing policy changes that they can bring back to their campuses

Comparison of outcomes in patients undergoing defibrillation threshold testing at the time of implantable cardioverter-defibrillator implantation versus no defibrillation threshold testing

Background: Inability to perform defibrillation threshold (DFT) testing during implantable cardioverter defibrillator (ICD) implantation due to co-morbidities may influence long-term survival. Methods: Retrospective review at The University of Michigan (1999-2004) identified 55 patients undergoing ICD implantation without DFT testing (“No-DFT group”). A randomly selected sample of patients (n = 57) undergoing standard DFT testing (“DFT group”) was compared in terms of appropriate shocks, clinical shock efficacy and all-cause mortality. Results: DFT testing was withheld due to hypotension, atrial fibrillation with inability to exclude left atrial thrombus, left ventricular thrombus, CHF and/or ischemia. The No-DFT group had a similar appropriate shock rate, but lower total survival (69.1% vs. 91.2%, p = 0.004) than the DFT group. The No-DFT group had a higher incidence of ventricular fibrillation (VF) episodes (9.1% vs. 3.1%, p = 0.037), and deaths attributable to VF (3 of 17 deaths vs. 0 of 5 deaths) compared to the DFT group. Multivariate analysis found a trend toward increased risk of death in the No-DFT group (HR 3.18, 95% CI 0.82-12.41, p = 0.095) after adjusting for baseline differences in gender distribution, NYHA class and prior CABG. Conclusions: In summary, overall mortality was higher in the No-DFT group. More deaths attributable to VF occurred in the No-DFT group. Thus, DFT testing should therefore remain the standard of care. Nevertheless, ICD therapy should not be withheld in patients who meet appropriate implant criteria simply on the basis of clinical scenarios that preclude routine DFT testing. (Cardiol J 2007; 14: 463-469

Porównanie wyników leczenia u pacjentów poddawanych lub niepoddawanych ocenie progu defibrylacji w czasie wszczepienia kardiowertera-defibrylatora

Wstęp: Brak możliwości przeprowadzenia oceny progu defibrylacji (DFT) podczas implantacji kardiowertera-defibrylatora (ICD) ze względu na występowanie współistniejących chorób może wpływać na przeżywalność w obserwacji odległej. Metody: W retrospektywnym przeglądzie przeprowadzonym na University of Michigan (1999-2004) zidentyfikowano 55 pacjentów, u których przeprowadzono implantację ICD bez oceny DFT. Grupę tą porównano pod względem występowania uzasadnionych wyładowań, ich klinicznej skuteczności oraz całkowitej śmiertelności z losowo wybraną grupą osób (n = 57), u których przeprowadzono standardową ocenę DFT. Wyniki: Oceny DFT nie dokonywano z powodu niskiej wartości ciśnienia tętniczego, migotania przedsionków z niemożnością wykluczenia skrzepliny w lewym przedsionku, skrzepliny w lewej komorze, zastoinowej niewydolności serca i/lub niedokrwienia. W grupie bez oceny DFT liczba uzasadnionych wyładowań była podobna, natomiast łączne przeżycie mniejsze (69,1% vs. 91,2%; p = 0,004) niż w grupie poddawanej ocenie DFT. W grupie bez oceny DFT stwierdzono większą częstość incydentów migotania komór (VF; 9,1% vs. 3,1%; p = 0,037) i zgonów z powodu VF (3 spośród 17 zgonów vs. 0 spośród 5 zgonów) ni¿ w grupie poddawanej ocenie DFT. W analizie wielozmiennej wykazano trend w kierunku zwiększonego ryzyka zgonów w grupie bez oceny DFT [iloraz hazardu (HR) 3,18; 95% przedział ufności (CI) 0,82–12,41; p = 0,095] po uwzględnieniu początkowych różnic rozkładu płci, klasy czynnościowej według Nowojorskiego Towarzystwa Kardiologicznego (NYHA) oraz wcześniejszego pomostowania tętnic wieńcowych. Wnioski: Całkowita śmiertelność była większa w grupie bez oceny DFT, gdzie wystąpiło więcej zgonów, które można było przypisywać VF. Ocena DFT powinna więc pozostać standardem postępowania. Mimo to nie należy rezygnować z leczenia za pomocą ICD u pacjentów, którzy spełniają kryteria implantacji, jeżeli jedynym powodem tego miałoby być występowanie sytuacji klinicznych wykluczających ocenę DFT

Syndemic factors associated with adult sexual HIV risk behaviors in a sample of Latino men who have sex with men in New York City

Objective: Syndemic theory has been proposed as a framework for understanding the role of multiple riskfactors driving the HIV epidemic among sexual and gender minority individuals. As yet, the frameworkhas been relatively absent in research on Latinos/as.Methods: We used logistic regression to assess relationships among cumulative syndemic conditions –including clinically significant depression, high-risk alcohol consumption, discrimination, and childhoodsexual abuse – engagement with multiple partners and condomless anal intercourse (CAI) in a sample of176 Latino men who have sex with men (MSM) in New York City.Results: In bivariate analyses, an increase in the number of syndemic factors experienced was associatedwith an increased likelihood of reporting multiple partners and CAI. In multivariable analyses, participantswith 2, 3, and 4 factors were significantly more likely to report multiple partners than those with 0(aOR = 4.66, 95% CI [1.29, 16.85); aOR = 7.28, 95% CI [1.94, 27.28] and aOR = 8.25, 95% CI [1.74, 39.24]respectively; p \u3c 0.05. Regarding CAI, only participants with 3 and 4 factors differed from those with 0aOR = 7.35, 95% CI [1.64, 32.83] and OR = 8.06, 95% CI [1.39, 46.73] respectively.Conclusions: Comprehensive approaches that address syndemic factors, and capitalize on resiliency, areneeded to address the sexual health needs of Latino MSM

Syndemic factors associated with adult sexual HIV risk behaviors in a sample of Latino men who have sex with men in New York City

Objective: Syndemic theory has been proposed as a framework for understanding the role of multiple riskfactors driving the HIV epidemic among sexual and gender minority individuals. As yet, the frameworkhas been relatively absent in research on Latinos/as.Methods: We used logistic regression to assess relationships among cumulative syndemic conditions –including clinically significant depression, high-risk alcohol consumption, discrimination, and childhoodsexual abuse – engagement with multiple partners and condomless anal intercourse (CAI) in a sample of176 Latino men who have sex with men (MSM) in New York City.Results: In bivariate analyses, an increase in the number of syndemic factors experienced was associatedwith an increased likelihood of reporting multiple partners and CAI. In multivariable analyses, participantswith 2, 3, and 4 factors were significantly more likely to report multiple partners than those with 0(aOR = 4.66, 95% CI [1.29, 16.85); aOR = 7.28, 95% CI [1.94, 27.28] and aOR = 8.25, 95% CI [1.74, 39.24]respectively; p \u3c 0.05. Regarding CAI, only participants with 3 and 4 factors differed from those with 0aOR = 7.35, 95% CI [1.64, 32.83] and OR = 8.06, 95% CI [1.39, 46.73] respectively.Conclusions: Comprehensive approaches that address syndemic factors, and capitalize on resiliency, areneeded to address the sexual health needs of Latino MSM

Integration of Social, Cultural, and Biomedical Strategies into an Existing Couple-Based Behavioral HIV/STI Prevention Intervention: Voices of Latino Male Couples

Introduction Successful HIV prevention and treatment requires evidence-based approaches that combine biomedical strategies with behavioral interventions that are socially and culturally appropriate for the population or community being prioritized. Although there has been a push for a combination approach, how best to integrate different strategies into existing behavioral HIV prevention interventions remains unclear. The need to develop effective combination approaches is of particular importance for men who have sex with men (MSM), who face a disproportionately high risk of HIV acquisition. Materials and Methods We collaborated with Latino male couples and providers to adapt Connect ‘n Unite, an evidence-based intervention for Black male couples, for Latino male couples. We conducted a series of three focus groups, each with two cohorts of couples, and one focus group with providers. A purposive stratified sample of 20 couples (N = 40, divided into two cohorts) and 10 providers provided insights into how to adapt and integrate social, cultural, and biomedical approaches in a couples-based HIV/AIDS behavioral intervention. Results The majority (N = 37) of the couple participants had no prior knowledge of the following new biomedical strategies: non-occupational post-exposure prophylaxis (nPEP); pre-exposure prophylaxis (PrEP); and HIV self-testing kits. After they were introduced to these biomedical interventions, all participants expressed a need for information and empowerment through knowledge and awareness of these interventions. In particular, participants suggested that we provide PrEP and HIV self-testing kits by the middle or end of the intervention. Providers suggested a need to address behavioral, social and structural issues, such as language barriers; and the promotion of client-centered approaches to increase access to, adaptation of, and adherence to biomedical strategies. Corroborating what couple participants suggested, providers agreed that biomedical strategies should be offered after providing information about these tools. Regarding culturally sensitive and responsive approaches, participants identified stigma and discrimination associated with HIV and sexual identity as barriers to care, language barriers and documentation status as further barriers to care, the couple-based approach as ideal to health promotion, and the need to include family topics in the intervention. Discussion We successfully adapted an evidence-based behavioral HIV prevention intervention for Latino male couples. The adapted intervention, called Conectando Latinos en Pareja, integrates social, cultural, behavioral and biomedical strategies to address the HIV epidemic among Latino MSM. The study highlights the promise regarding the feasibility of implementing a combination approach to HIV prevention in this populatio