Perceived discrimination experiences and social well-being among midlife and older adult men who have sex with men from the Multicenter AIDS Cohort Study

Many men who have sex with men (MSM) in midlife (40-64 years) and older adulthood (65+ years) have survived a lifetime fighting and advocating for equality given exposures to social discrimination attributed to stigmatized social identities (e.g., sexual orientation, racial/ethnic minority, and HIV-positive status). Few public health research efforts have given attention to how MSM’s exposure and salience of social discrimination across the life course have shaped social well-being in midlife and older age. Three studies were conducted using a cross-sectional healthy aging sub-study of the Multicenter AIDS Cohort Study (MACS). Study 1 explored whether older adulthood, racial/ethnic minorities, and HIV+ serostatus were associated with higher prevalence of any lifetime, any sexuality-related, and multifactorial (number of discrimination types) discrimination. Non-Hispanic Blacks were associated with greater any lifetime discrimination (aOR=1.42, p<0.001) and associated with less sexuality-related discrimination (aOR=0.56, p=0.001) compared to Non-Hispanic Whites. There was a statistically significant interaction associated to multifactorial discrimination between Non-Hispanic Black identity and HIV serostatus (aOR=0.46, p=0.019). Interestingly, no statistically significant differences in discrimination were observed by age cohort. Study 2 examined current internalized homophobia by discrimination exposure and salience. We observed no statistically significant differences in internalized homophobia by any discrimination or salience variables. Study 3 assessed differences in six indicators of social well-being (attachment, social integration, guidance, reassurance of worth, reliable alliance, and opportunity for nurturance) by discrimination exposure and salience. Though the mean scores for social well-being indicators were high overall, both any lifetime discrimination and multifactorial discrimination were negatively associated with indicator scores except opportunity for nurturance. Sexuality-related discrimination was negatively associated with social integration only. Across all discrimination salience variables, participants who reported discrimination and no/low salience exhibited lower scores on social well-being indicators than participants who reported no discrimination. Study 3 extended the public health literature on aging MSM, elucidating the role of salience on discrimination’s relationship to social well-being and that despite social adversity, these men have been able to maintain or achieve high social well-being. Future research should continue exploring midlife and older adult MSM’s resiliencies to identify factors that interrupt the deleterious impact of discrimination on health

Discrimination, Coping, and Depression among Black Men Who Have Sex with Men

Black men who have sex with men (BMSM) have elevated risk for depression compared to the general population. BMSM’s capacity to cope with these experiences is not well understood. Increased understanding of how multiple forms of discrimination contribute to depression and how BMSM cope with discrimination can better inform interventions. Data come from 3,510 BMSM who attended Black Pride events in six U.S. cities from 2015-2017. Participants completed a health survey that ascertained their psychosocial health and resiliency profiles. Using multivariable logistic regression models, we tested the associations between type-specific discrimination (race, sexuality, HIV status) and depression. We then conducted sub-analyses to determine if coping attenuated the association between type-specific discrimination and depression. Our findings indicated that increased odds of depression among BMSM were associated with discrimination based on race (aOR=1.38, 95% CI = 1.08-1.76), sexual orientation (aOR=1.32, 95% CI = 1.01-1.72), and HIV status (aOR=1.53, 95% CI = 1.08-2.17). Sub-analyses indicated coping had inconsistent moderation effects between type-specific discrimination and depression. Our findings demonstrate that impact of various forms of discrimination on BMSM’s mental health and the mitigating role of coping. Interventions should seek to address depression by reducing experiences of discrimination and building coping resiliency

Employing Position Generators to Assess Social Capital and Health: A Scoping Review of the Literature and Recommendations for Measurement in Future Population-Based Surveillance

Beneficial social connections are critical to individual-level health because they can be used to avoid or minimize the risks and consequences associated with diseases. How to best measure beneficial social connections to inform social network-level health interventions remains poorly understood. A scoping review of health surveillance studies was conducted to highlight the utility of employing position generators to assess how access to beneficial social connections was associated with population health and disparities. Our review yielded 39 articles conducted across 14 predominantly high-income countries. Most studies (77%) with composite measures for beneficial social connections exhibited health-protective associations. Of the remaining articles, half found that greater diversity within one’s network was associated with positive health outcomes. Only eight articles accounted for differences by advantaged statuses, indicating that beneficial connections elicited greater health-protective associations among disadvantaged groups. Employing position generators may inform interventions that seek to reduce health disparities by enhancing social capital in individuals from disadvantaged backgrounds

Send Orders for Reprints to [email protected] PrEP Awareness and Perceived Barriers Among Single Young Men who have Sex with Men

Abstract: Pre-exposure prophylaxis (PrEP) has the potential to help reduce new HIV infections among young men who have sex with men (YMSM). Using a cross-sectional survey of YMSM (N=1,507; ages 18-24), we gauged YMSM&apos;s PrEP awareness and PrEP-related beliefs regarding side effects, accessibility, and affordability. Overall, 27% of the sample had heard about PrEP; 1% reported ever using PrEP prior to sex. In a multivariate logistic regression, we found that YMSM were more likely to have heard about PrEP if they were older, more educated, were residentially unstable in the prior 30 days, had insurance, or reported having at least one sexually transmitted infection in their lifetime. We found no differences by race/ethnicity, history of incarceration, or recent sexual risk behavior. In multivariate linear regression models, Black and Latino YMSM were more likely than Whites to state they would not use PrEP because of side effect concerns. YMSM were more likely to indicate that they would not be able to afford PrEP if they did not have insurance or if they had a prior sexually transmitted infection, PrEP rollout may be hindered due to lack of awareness, as well as perceived barriers regarding its use. We propose strategies to maximize equity in PrEP awareness and access if it is to be scaled up among YMSM

Toward Using Twitter for PrEP-Related Interventions: An Automated Natural Language Processing Pipeline for Identifying Gay or Bisexual Men in the United States

BackgroundPre-exposure prophylaxis (PrEP) is highly effective at preventing the acquisition of HIV. There is a substantial gap, however, between the number of people in the United States who have indications for PrEP and the number of them who are prescribed PrEP. Although Twitter content has been analyzed as a source of PrEP-related data (eg, barriers), methods have not been developed to enable the use of Twitter as a platform for implementing PrEP-related interventions. ObjectiveMen who have sex with men (MSM) are the population most affected by HIV in the United States. Therefore, the objectives of this study were to (1) develop an automated natural language processing (NLP) pipeline for identifying men in the United States who have reported on Twitter that they are gay, bisexual, or MSM and (2) assess the extent to which they demographically represent MSM in the United States with new HIV diagnoses. MethodsBetween September 2020 and January 2021, we used the Twitter Streaming Application Programming Interface (API) to collect more than 3 million tweets containing keywords that men may include in posts reporting that they are gay, bisexual, or MSM. We deployed handwritten, high-precision regular expressions—designed to filter out noise and identify actual self-reports—on the tweets and their user profile metadata. We identified 10,043 unique users geolocated in the United States and drew upon a validated NLP tool to automatically identify their ages. ResultsBy manually distinguishing true- and false-positive self-reports in the tweets or profiles of 1000 (10%) of the 10,043 users identified by our automated pipeline, we established that our pipeline has a precision of 0.85. Among the 8756 users for which a US state–level geolocation was detected, 5096 (58.2%) were in the 10 states with the highest numbers of new HIV diagnoses. Among the 6240 users for which a county-level geolocation was detected, 4252 (68.1%) were in counties or states considered priority jurisdictions by the Ending the HIV Epidemic initiative. Furthermore, the age distribution of the users reflected that of MSM in the United States with new HIV diagnoses. ConclusionsOur automated NLP pipeline can be used to identify MSM in the United States who may be at risk of acquiring HIV, laying the groundwork for using Twitter on a large scale to directly target PrEP-related interventions at this population

Topics for Inclusive Parent-Child Sex Communication by Gay, Bisexual, Queer Youth

The purposes of this study were to identify the sexuality-related topics parents and gay, bisexual, or queer (GBQ) adolescent males discussed at home and to describe the topics GBQ adolescent males recommend for parents to discuss with future cohorts of GBQ youth. Minimal research on parent-child sex communication with sexual minority adolescents prevents the development of interventions that would benefit adolescent males with same-sex attractions, behaviors and identities. As part of a multimethod qualitative study, we interviewed 30 GBQ adolescent males ages 15-20 and asked them to perform card sorts. From a list of 48 topics, we explored sexuality-related issues GBQ males were familiar with, the topics they discussed with a parent, and topics they suggested parents address with GBQ males at home. Most participants reported that parents assumed them heterosexual during sex talks prior to GBQ adolescent males\u27 coming out. Participants challenged the heteronormative scripts used by parents when discussing sex and health. Participants identified sexuality topics that parents did not routinely cover during sex talks, but that GBQ youth felt would have been useful for them growing up with emergent identities. A non-heteronormative approach to parent-child sex communication is recommended to provide appropriate guidance about sex and HIV/STI prevention to this youth population. Our findings highlight a need to reconfigure parental sexuality scripts to be more inclusive when assisting GBQ males navigate adolescence