DRAFT Report:Community Systems Strengthening Toward a Research Agenda

Communities have a long history of acting to preserve and promote the health of their members. Public health researchers, programmers, and funders are increasingly recognizing that community involvement is essential to improving health, especially among populations that are disproportionately affected by HIV. The Global Fund to fight AIDS, Tuberculosis and Malaria, together with civil society organizations and other development partners, created the Community Systems Strengthening (CSS) Framework to help Global Fund applicants frame, define, and quantify efforts to strengthen community contributions engagement (Global Fund 2011). Although the use of a CSS approach in health programming implementation shows promise, it lacks a theoretical framework to guide collaborations with communities. Additionally, it suffers from a paucity of program designs and evaluation practices, an incomplete evidence-based rationale for investing in CSS, and imprecise definitions (e.g., what is meant by “community” and “CSS”).The purpose of this paper is to highlight promising areas for future research related to CSS. Toward this objective, we propose to lay a foundation for a CSS research agenda by using theories and approaches relevant to CSS, reinforced with evidence from projects that employ similar approaches

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

Human Sexuality and Social Justice: Structual Impacts on Well Being

This lecture is part of the Expanding The Frame series of talks sponsored by the Office of Diversity and Inclusion at CIIS.https://digitalcommons.ciis.edu/diversityandinclusion-lectures/1003/thumbnail.jp

La desesperacion in Latino migrant day laborers and its role in alcohol and substance-related sexual risk

The purpose of this study was to better understand the relation between psychological distress and alcohol and substance related sexual risk in Latino migrant day laborers (LMDLs). In addition to examining the roles of depression and anxiety, it was also necessary to examine the role of desesperación, a popular Latino idiom of distress frequently expressed by LMDLs in response to the thwarting of major migration related life goals such as traveling to the U.S. in search of work to support families, projects and purchases in country of origin. Given the structural vulnerability of LMDLs to under-employment and frequent unemployment, LMDLs also refer to desesperación as a prelude to problem drinking, substance use, and sexual risk taking. Hence we developed and validated a scale of desesperación for LMDLs to explore this culturally relevant construct of psychological distress in this unique population of Latinos. Based on a cross sectional survey of 344 LMDLs, this study found that the dissatisfaction subscale of desesperación predicted alcohol-related sexual risk taking, while depression predicted substance-related sexual risk taking. These findings are discussed including implications of preventing alcohol and substance related sexual risk taking in LMDLs

La desesperación in Latino migrant day laborers and its role in alcohol and substance-related sexual risk

The purpose of this study was to better understand the relation between psychological distress and alcohol and substance related sexual risk in Latino migrant day laborers (LMDLs). In addition to examining the roles of depression and anxiety, it was also necessary to examine the role of desesperación, a popular Latino idiom of distress frequently expressed by LMDLs in response to the thwarting of major migration related life goals such as traveling to the U.S. in search of work to support families, projects and purchases in country of origin. Given the structural vulnerability of LMDLs to under-employment and frequent unemployment, LMDLs also refer to desesperación as a prelude to problem drinking, substance use, and sexual risk taking. Hence we developed and validated a scale of desesperación for LMDLs to explore this culturally relevant construct of psychological distress in this unique population of Latinos. Based on a cross sectional survey of 344 LMDLs, this study found that the dissatisfaction subscale of desesperación predicted alcohol-related sexual risk taking, while depression predicted substance-related sexual risk taking. These findings are discussed including implications of preventing alcohol and substance related sexual risk taking in LMDLs. Keywords: Latinos, Desesperación, Depression, Anxiety, Alcohol, Substance, Sexual ris

La desesperacion in Latino migrant day laborers and its role in alcohol and substance-related sexual risk

The purpose of this study was to better understand the relation between psychological distress and alcohol and substance related sexual risk in Latino migrant day laborers (LMDLs). In addition to examining the roles of depression and anxiety, it was also necessary to examine the role of desesperación, a popular Latino idiom of distress frequently expressed by LMDLs in response to the thwarting of major migration related life goals such as traveling to the U.S. in search of work to support families, projects and purchases in country of origin. Given the structural vulnerability of LMDLs to under-employment and frequent unemployment, LMDLs also refer to desesperación as a prelude to problem drinking, substance use, and sexual risk taking. Hence we developed and validated a scale of desesperación for LMDLs to explore this culturally relevant construct of psychological distress in this unique population of Latinos. Based on a cross sectional survey of 344 LMDLs, this study found that the dissatisfaction subscale of desesperación predicted alcohol-related sexual risk taking, while depression predicted substance-related sexual risk taking. These findings are discussed including implications of preventing alcohol and substance related sexual risk taking in LMDLs

Barriers to and enablers of the HIV services continuum among gay and bisexual men worldwide: Findings from the Global Men's Health and Rights Study.

ObjectivesTo assess ecological, structural, community and individual level correlates of health services utilization along a continuum of HIV care, and sexual health and support services among gay and bisexual men worldwide.MethodsUsing a nonprobability internet sample of 6,135 gay and bisexual men, we assessed correlates of utilization of health services. Chi-Square Tests of Independence were performed to assess drop off along a continuum of HIV care. Multivariable logistic regression analyses using generalized estimating equation models were conducted adjusting for geographic region and clustering by country. In multivariable analyses, we determined the association between utilization outcomes, and ecologic, structural, community and individual correlates by fitting separate generalized estimating equation (GEE) logistic regression models for each of the outcomes, fitted with robust SEs, and accounting for clustering by country. Stratified by sexual identity, analyses adjusted for variables that could influence HIV-related health outcomes including racial/ethnic minority status, participant age, insurance, ability to make ends meet, as well as country-level income (income of country of residence defined by the World Bank).ResultsAmong men living with HIV (n = 1001), being in HIV care (n = 867) was associated with being on ART (X2 = 191.17, p ConclusionsIt is essential that barriers to health services utilization be addressed at structural and community levels. Structural interventions should be designed to reduce sexual stigma, as well as train and sensitize healthcare providers; and strengthen community level interventions that bring gay and bisexual men together to lead comprehensive health services

Sexual pleasure and sexual risk among women who use methamphetamine: A mixed methods study

International audienc