The Association of Food Insecurity, Mental Health, and Healthcare Access and Use Among Lesbian, Gay, and Bisexual Adults in the United States: Results From the 2021 National Health Interview Survey

Purpose We sought to describe the prevalence of food insecurity and its relationship with mental health, health care access, and use among lesbian, gay, and bisexual (LGB) adults in the U.S. Design and Setting We analyzed data from the National Health Interview Survey (NHIS), a cross-sectional study of noninstitutionalized adults from all 50 states and the District of Columbia. Sample The study sample was restricted to LGB adults ≥18 years (N = 1178) from the 2021 NHIS survey. Measures Food security was assessed using the 10-item U.S Adult Food Security Survey Module. Study outcomes were mental health (depression, anxiety, life satisfaction, and serious psychological distress), health care utilization, and medication adherence. Analysis Descriptive statistics and linear and generalized linear regressions. Results The study sample consisted of 69% White, 14% Hispanic/Latinx, 9% Black, and 8% people of other races. Approximately half (53%) identified as bisexual and 47% identified as gay or lesbian. Eleven percent were food insecure. Sexual orientation, income-to-poverty ratio, and health insurance were significant correlates of food insecurity. In multivariable analyses, food insecurity was significantly associated with mental illness (including depression, anxiety, and serious psychological distress), limited health care access and use (including inability to pay medical bills, delay in getting medical and mental health care, and going without needed medical and mental health care), and medication nonadherence (including skipping medication, taking less medication, delay filling prescription, and going without needed prescription). Conclusion Food insecurity is a constant predictor of adverse mental health and low medical and mental health care use rates among LGB adults in the United States. Achieving food security in LGB people requires improving their financial and nonfinancial resources to obtain food

Community Healthcare Providers’ Perspectives on HIV Pre-Exposure Prophylaxis (PrEP) Use among Black Women

The most at-risk population among women for HIV diagnosis in the U.S. are Black women, who account for 61% of all new HIV cases. Pre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention method for people at risk of HIV acquisition. Despite being disproportionately affected by HIV, Black women’s knowledge, perceived benefits, and uptake of PrEP remain low. The socio-ecological model may be useful for understanding why there is a low uptake of PrEP among Black women by examining the complex interplay between individual, relationship, community, and societal factors. The current study used the socio-ecological framework to explore provider perspectives on the barriers and facilitators of PrEP uptake among Black women in Eastern Virginia. Semi-structured interviews were conducted with a purposeful sample of one PrEP prescriber and 14 community healthcare workers. Healthcare providers identified barriers to PrEP uptake among Black women at the individual (e.g., basic needs not met, lack of childcare, low medical literacy), interpersonal (e.g., perception partner(s) are safe), community (e.g., long waitlists, military culture lacks anonymity), organizational (e.g., clinic materials focus on men), and societal (e.g., PrEP ads focus on gay men, stigma, lack of trust in the medical community) levels. Providers also identified factors that facilitate PrEP uptake at the individual (e.g., flexible work schedule, current/past STI diagnosis), interpersonal (e.g., partner is HIV positive), organizational (e.g., more female screeners/providers, PrEP materials that include women, encouraging PrEP for everyone), community (e.g., making PrEP information available where Black women go), and societal (e.g., HIV education in schools) levels. These findings highlight unique barriers to accessing and taking PrEP for Black women in the U.S., and potential factors that could facilitate PrEP use. Examining barriers and facilitators may be important to guide future research that considers multi-level interventions to improve uptake of PrEP among Black women.https://digitalcommons.odu.edu/gradposters2023_sciences/1002/thumbnail.jp

Experiences with COVID-19 Stress Among Hispanic/Latino Farmworkers

BACKGROUND: Hispanics/Latinos, particularly those that identify as foreign-born, are overrepresented in the agricultural sector in the U.S. Over the course of the COVID-19 pandemic, this subpopulation of farmworkers was recognized as an invaluable group of essential workers unable to implement COVID-19 protections. METHODS: Previously validated COVID-19 stress scale measures were identified, adapted, and translated to collect COVID-19 stress data from Hispanic/Latino agricultural workers in two heavily agricultural counties in northeastern North Carolina. Participants were recruited using purposive convenience sampling. Data collection took place from June to November of 2021. RESULTS: The majority of Hispanic/Latino agricultural workers surveyed reported experiencing worries about catching COVID-19 (92.00%) and being infected with the virus (95.95%). A small proportion of the surveyed population indicated experiencing COVID-19 traumatic stress. More than half of participants were concerned about the impacts COVID-19 would have on their ability to see (53.42%) and provide for their families (58.33%). CONCLUSION: Farmworkers bore relatively heavy stress burdens associated with the COVID-19 pandemic. Because this group is a vulnerable population at risk for adverse health outcomes, reports numerous barriers to healthcare access, and faces health and safety challenges related to acculturative stress, understanding their experiences with COVID-19 is essential for the development of protective and preventative efforts to improve outcomes among Hispanic/Latino farmworkers

Unconditional Government Cash Transfer In Support of Orphaned and Vulnerable Adolescents in Western Kenya: Is There an Association with Psychological Wellbeing?

Background Orphaned and vulnerable adolescents (OVA) in sub-Saharan Africa are at greater risk for adverse psychological outcomes compared with their non-OVA counterparts. Social interventions that provide cash transfers (CTs) have been shown to improve health outcomes among young people, but little is known about their impact on the psychological wellbeing of OVA. Objective Among OVA in western Kenya, we assessed the association between living in a household that received monthly unconditional government CTs and psychological wellbeing. Methods We examined the likelihood of depression, anxiety, post-traumatic stress symptoms (PTSS) and positive future outlook among 655 OVA aged between 10 and 18 years who lived in 300 randomly selected households in western Kenya that either received or did not receive unconditional monthly CTs. Results The mean age was 14.0 (SD 2.4) years and 329 (50.2%) of the participants were female while 190 (29.0%) were double orphans whose biological parents were both deceased. After adjusting for socio-demographic, caregiver, and household characteristics and accounting for potential effects of participant clustering by sub-location of residence, OVA living in CT households were more likely to have a positive future outlook (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.08, 1.99), less likely to be anxious (OR 0.57, 95% CI 0.42, 0.78), and less likely to have symptoms of post-traumatic stress (OR 0.50, 95% CI 0.29, 0.89). We did not find statistically significant differences in odds of depression by CT group. Conclusion OVA in CT households reported better psychological wellbeing compared to those in households not receiving CTs. CT interventions may be effective for improving psychological wellbeing among vulnerable adolescents in socioeconomically deprived households

Integrating HIV and mental health interventions to address a global syndemic among men who have sex with men

In this Series paper, we review evidence on the co-occurring and synergistic epidemics (syndemic) of HIV and mental health problems worldwide among men who have sex with men (MSM). The multilevel determinants of this global syndemic include structural factors that enable stigma, systematic bias, and violence towards MSM across geographical and cultural contexts. Cumulative exposure to these factors over time results in population-level inequities in the burden of HIV infections and mental health problems among MSM. Evidence for this syndemic among MSM is strongest in the USA, Canada, western Europe, and parts of Asia and Latin America, with emerging evidence from sub-Saharan Africa. Integrated interventions are needed to address syndemics of HIV and mental health problems that challenge the wellbeing of MSM populations worldwide, and such interventions should consider various mental health conditions (eg, depression, anxiety, trauma, and suicidality) and their unique expressions and relationships with HIV outcomes depending on cultural contexts. In addition, interventions should identify and intervene with locally relevant structural factors that result in HIV and mental health vulnerabilities among MSM

Unconditional government cash transfers in support of orphaned and vulnerable adolescents in western Kenya: Is there an association with psychological wellbeing?

Background: Orphaned and vulnerable adolescents (OVA) in sub-Saharan Africa are at greater risk for adverse psychological outcomes compared with their non-OVA counterparts. Social interventions that provide cash transfers (CTs) have been shown to improve health outcomes among young people, but little is known about their impact on the psychological wellbeing of OVA. Objective: Among OVA in western Kenya, we assessed the association between living in a household that received monthly unconditional government CTs and psychological wellbeing. Methods: We examined the likelihood of depression, anxiety, post-traumatic stress symptoms (PTSS) and positive future outlook among 655 OVA aged between 10 and 18 years who lived in 300 randomly selected households in western Kenya that either received or did not receive unconditional monthly CTs. Results: The mean age was 14.0 (SD 2.4) years and 329 (50.2%) of the participants were female while 190 (29.0%) were double orphans whose biological parents were both deceased. After adjusting for socio-demographic, caregiver, and household characteristics and accounting for potential effects of participant clustering by sub-location of residence, OVA living in CT households were more likely to have a positive future outlook (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.08, 1.99), less likely to be anxious (OR 0.57, 95% CI 0.42, 0.78), and less likely to have symptoms of post-traumatic stress (OR 0.50, 95% CI 0.29, 0.89). We did not find statistically significant differences in odds of depression by CT group. Conclusion: OVA in CT households reported better psychological wellbeing compared to those in households not receiving CTs. CT interventions may be effective for improving psychological wellbeing among vulnerable adolescents in socioeconomically deprived households

Experiences of Kenyan Healthcare Workers Providing Services to Men Who Have Sex With Men: Qualitative Findings from a Sensitivity Training Programme

Introduction Men who have sex with men (MSM) in Kenya are at high risk for HIV and may experience prejudiced treatment in health settings due to stigma. An on-line computer-facilitated MSM sensitivity programme was conducted to educate healthcare workers (HCWs) about the health issues and needs of MSM patients. Methods Seventy-four HCWs from 49 ART-providing health facilities in the Kenyan Coast were recruited through purposive sampling to undergo a two-day MSM sensitivity training. We conducted eight focus group discussions (FGDs) with programme participants prior to and three months after completing the training programme. Discussions aimed to characterize HCWs’ challenges in serving MSM patients and impacts of programme participation on HCWs’ personal attitudes and professional capacities. Results Before participating in the training programme, HCWs described secondary stigma, lack of professional education about MSM, and personal and social prejudices as barriers to serving MSM clients. After completing the programme, HCWs expressed greater acknowledgement of MSM patients in their clinics, endorsed the need to treat MSM patients with high professional standards and demonstrated sophisticated awareness of the social and behavioural risks for HIV among MSM. Conclusions Findings provide support for this approach to improving health services for MSM patients. Further efforts are needed to broaden the reach of this training in other areas, address identified barriers to HCW participation and evaluate programme effects on patient and HCW outcomes using rigorous methodology

Cultural adaptation and validation of a measure of prejudice against men who have sex with men among healthcare providers in western Kenya

Sexual prejudice toward men who have sex with men (MSM) is a pressing concern in sub-Saharan Africa (SSA). Given the high HIV infection risk among this population, sexual prejudice perpetuated by healthcare providers, affects access to and willingness of MSM to seek HIV care services. However, data on healthcare providers’ attitudes towards MSM in SSA are limited, and there are no locally-adapted measures of sexual prejudice. We adapted a scale to measure sexual prejudice with a sample of 147 healthcare providers in western Kenya. Results from exploratory factor analysis revealed a single-factor structure. The scale demonstrated high internal consistency with Cronbach’s α = 0.91. Healthcare providers who had prior interpersonal contact with MSM, had ever been trained on counselling MSM, and had higher knowledge about MSM health needs reported lower sexual prejudice scores, compared with peers who lacked these experiences (p < 0.001). In contrast, healthcare providers who had experienced secondary stigma (negative judgments from peers and community) for providing care to MSM reported higher scores of sexual prejudice scale (p < 0.001) compared with providers who had not experienced secondary stigma. The scale provides a contextualised tool to assess healthcare providers’ attitudes toward MSM in Kenya and countries in SSA with similar cultural norms

Childhood sexual abuse, alcohol and drug use problems among Black sexual minority men in six US Cities: Findings from the HPTN 061 study.

BackgroundPrior research has found a high prevalence of childhood sexual abuse (CSA) among sexual minority men (SMM) in the US, and has indicated that CSA is associated with higher rates of alcohol and drug use disorders. However, most of these studies have focused almost exclusively on White SMM. We assessed associations of CSA, alcohol use, and drug use problems among adult Black SMM.MethodsParticipants were 1,016 Black SMM recruited from six US cities (Atlanta, Boston, Los Angeles, New York City, San Francisco, and Washington, DC) between July 2009 and December 2011. We used hierarchical logistic regression to evaluate the associations between CSA, alcohol use problems (≥ 8 AUDIT), and drug use problems (excluding marijuana).ResultsMean (SD) age was 37.8 (11.7) years, and 28.6% and 49.2% reported alcohol and drug use disorders in the past six months, respectively. Most of the study participants reported history of CSA (70.3%). Adjusting for sociodemographic and confounding variables, CSA was associated with higher odds of alcohol use problems (odds ratio (OR) = 1.52, 95% CI 1.09, 2.12) and drug use problems (OR = 1.58, 95% CI 1.19, 2.10) than non-CSA group.ConclusionPrevalence of CSA is high among BSMM in the US and is positively associated with alcohol and drug use problems. Substance use interventions should address the psychological health needs of BSMM with a history of CSA