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1.  It Gets Better: Resolution of Internalized Homophobia over Time and Associations with Positive Health Outcomes among MSM 
AIDS and behavior  2013;17(4):1423-1430.
Health disparities research among gay and bisexual men has focused primarily on risk and deficits. However, a focus on resiliencies within this population may greatly benefit health promotion. We describe a pattern of resilience (internalized homophobia (IHP) resolution) over the life-course and its associations with current health outcomes. 1,541 gay and bisexual men from the Multi-Center AIDS Cohort study, an ongoing prospective study of the natural and treated histories of HIV, completed a survey about life-course events thought to be related to health. The majority of men resolved IHP over time independent of demographics. Men who resolved IHP had significantly higher odds of positive health outcomes compared to those who did not. These results provide evidence of resilience among participants that is associated with positive health outcomes. Understanding resiliencies and incorporating them into interventions may help to promote health and well-being among gay and bisexual men.
doi:10.1007/s10461-012-0392-x
PMCID: PMC3708613  PMID: 23283578
Gay men’s health; Resilience; Internalized Homophobia; MSM Health Promotion; Syndemics
2.  Methamphetamine and Young Men who have Sex with Men: Patterns, Correlates and Consequences of Use 
Objectives
To examine patterns, consequences and correlates of methamphetamine use among adolescent/young adult men who have sex with men (YMSM).
Design
Descriptive, bivariate and hierarchical regression analyses of cross-sectional data.
Setting
Howard Brown Health Center, a community-based facility in Chicago, IL from 2004-2005.
Participants
310 YMSM age 16-24 completed an anonymous, computer-assisted survey.
Main Outcome Measure
Methamphetamine use in the past year.
Results
Participants ranged in age from 16-24 years (M=20.3); 70% were of color. Participants reported a number of high-risk sexual and substance use behaviors. Thirteen percent used methamphetamine in the past year. Methamphetamine use was more common among HIV-infected participants, odds ratio (OR) = 2.8; 95% confidence interval (CI) = 1.3-5.3, and varied by age and race/ethnicity; substantially higher prevalence was reported by older and non African-American YMSM (p<0.001). Compared to other illicit substance users, methamphetamine users reported more memory difficulties, impairments in daily activities and unintended risky sex resulting from substance use (all p<0.01). Hierarchical regression identified sexual risk (unprotected intercourse and multiple partners), sexualized social context (e.g. internet sex, sex in a bathhouse/sex club, sex with older partners, and commercial sex), lower self-esteem and psychological distress as correlated with methamphetamine use among participants (p<0.05).
Conclusions
A substantial proportion of YMSM in this sample use methamphetamine. Methamphetamine use is a public health problem with significant implications for the health and well-being of adolescent/young adult MSM. Methamphetamine use was associated with HIV-related risk and patterns of use were predicted by demographics, sexualized social contexts, and psychological variables.
doi:10.1001/archpedi.161.6.591
PMCID: PMC3985401  PMID: 17548765
3.  Application of Syndemic Theory to Black Men Who Have Sex with Men in the Multicenter AIDS Cohort Study 
This study analyzed data from a large prospective epidemiologic cohort study among men who have sex with men (MSM), the Multicenter AIDS Cohort Study, to assess syndemic relationships among Black MSM in the cohort (N = 301). We hypothesized that multiple interconnections among psychosocial health conditions would be found among these men, defining syndemic conditions. Constituents of syndemic conditions measured included reported depression symptoms, sexual compulsiveness, substance use, intimate partner violence (IPV), and stress. We found significant evidence of syndemics among these Black men: depression symptoms were independently associated with sexual compulsiveness (odds ratios [OR]: 1.88, 95% CI = 1.1, 3.3) and stress (OR: 2.67, 95% CI = 1.5, 4.7); sexual compulsiveness was independently associated with stress (OR: 2.04, 95% CI = 1.2, 3.5); substance misuse was independently associated with IPV (OR: 2.57, 95% CI = 1.4, 4.8); stress independently was associated with depression symptoms (OR: 2.67, 95% CI = 1.5, 4.7), sexual compulsiveness (OR: 2.04, 95% CI = 1.2, 3.5) and IPV (OR: 2.84, 95% CI = 1.6, 4.9). Moreover, men who reported higher numbers of syndemic constituents (three or more conditions) reportedly engaged in more unprotected anal intercourse compared to men who had two or fewer health conditions (OR: 3.46, 95% CI = 1.4–8.3). Findings support the concept of syndemics in Black MSM and suggest that syndemic theory may help explain complexities that sustain HIV-related sexual transmission behaviors in this group.
doi:10.1007/s11524-012-9674-x
PMCID: PMC3535137  PMID: 22383094
HIV; Syndemics; Black men; Sexual risk; Epidemiology
4.  Adversity and Syndemic Production Among Men Participating in the Multicenter AIDS Cohort Study: A Life-Course Approach 
Objectives
We tested a theory of syndemic production among men who have sex with men (MSM) using data from a large cohort study.
Methods
Participants were 1551 men from the Multicenter AIDS Cohort Study enrolled at 4 study sites: Baltimore, Maryland–Washington, DC; Chicago, Illinois; Los Angeles, California; and Pittsburgh, Pennsylvania. Participants who attended semiannual visits from April 1, 2008, to March 31, 2009, completed an additional survey that captured data about events throughout their life course thought to be related to syndemic production.
Results
Using multivariate analysis, we found that the majority of life-course predictor variables (e.g., victimization, internalized homophobia) were significantly associated with both the syndemic condition and the component psychosocial health outcomes (depressive symptoms, stress, stimulant use, sexual compulsivity, intimate partner violence). A nested negative binomial analysis showed that the overall life course significantly explained variability in the syndemic outcomes (χ2 = 247.94; P < .001; df = 22).
Conclusions
We identified life-course events and conditions related to syndemic production that may help to inform innovative interventions that will effectively disentangle interconnecting health problems and promote health among MSM.
doi:10.2105/AJPH.2012.300810
PMCID: PMC3518355  PMID: 23153154
5.  Sex While Intoxicated: A Meta-Analysis Comparing Heterosexual and Sexual Minority Youth 
Background
The social marginalization and victimization experienced by sexual minority youth (SMY) may lead to increased risk behaviors and higher rates of negative health outcomes compared with their heterosexual peers.
Methods
We conducted a meta-analysis to examine whether SMY reported higher rates of sex while intoxicated. Studies that report rates of substance use during sex in both SMY and heterosexual youth and had a mean participant age of 18 or less were included in our meta-analysis. Effect sizes were extracted from six studies (nine independent data sets and 24 effect sizes) that met study criteria and had high inter-rater reliability (.98).
Results
Results indicated that SMY were almost twice as likely to report sex while intoxicated as compared with heterosexual peers. A random-effects meta-analysis showed a moderate ([overall weighted effect OR]= 1.91, p < .0001) weighted effect size for the relationship between sexual orientation and the use of drugs at the time of sexual intercourse, with the mean effect size for each study ranging from 1.21 to 3.50 and individual effect sizes ranging from .35 to 9.86.
Discussion
Our findings highlight the need for healthcare providers to screen SMY for participation in substance use during sexual intercourse and to offer risk reduction counseling during office visits.
doi:10.1016/j.jadohealth.2010.07.008
PMCID: PMC3691819  PMID: 21338904
LGBT health; Adolescent health; Health disparities; Adolescent sexual health
6.  Changes in Stimulant Drug Use Over Time in the MACS: Evidence for Resilience Against Stimulant Drug Use Among Men Who Have Sex with Men 
AIDS and Behavior  2012;16(1):151-158.
Stimulant drug use is associated with numerous health problems among men who have sex with men (MSM). This paper describes how stimulant drug use changes over a four and one-half year period from 2003 until 2008. Participants were 2,389 men (17,222 person-visits) from The Multicenter AIDS Cohort Study (MACS)—an ongoing, prospective study of HIV infection among MSM. Group-based trajectory analyses of data from these men over the study period yielded a four groups solution: consistent users (9.8%), men whose use increased (5.4%), men whose use declined (6.9%), and abstinent or rarely-using men (77.9%). There were significant differences between groups in terms of demographic, behavioral risk and HIV serostatus. Men who increased or decreased stimulant drug use over time reported congruent changes in sexual risk taking. The fact that sexual risk levels parallel stimulant drug use over time suggests that finding ways to lower rates of stimulant drug use among MSM could be a tool in HIV prevention.
doi:10.1007/s10461-010-9866-x
PMCID: PMC3133874  PMID: 21191644
Drug use; Gay men’s health; HIV risk behavior; MSM; Stimulant use
7.  Mental Health and HIV Risk in Men Who Have Sex with Men 
Evidence-based HIV prevention interventions with men who have sex with men (MSM) in the United States have moderate effect sizes in reducing HIV sexual risk behavior. Mental health and psychosocial problems, which both disproportionately affect MSM populations and are implicated in HIV transmission risk behaviors, also likely interfere with the uptake of HIV behavioral interventions. Moreover, given that mental health and psychosocial problems such as depression, substance use, and violence frequently co-occur for many MSM (eg, as “syndemic conditions”), what is probably needed are combination prevention efforts, or prevention “cocktails,” similar to treatment “cocktails,” that address the psychological and behavioral mechanisms that interact to produce elevated risk for HIV. Such interventions should incorporate a holistic framework to address the sexual health and overall well-being of MSM. Addressing co-occurring psychosocial risk factors is apt to improve effect sizes of current HIV prevention interventions and allow for more effective uptake by MSM.
doi:10.1097/QAI.0b013e3181fbc939
PMCID: PMC3074520  PMID: 21406991
8.  Transgender Female Youth and Sex Work: HIV Risk and a Comparison of Life Factors Related to Engagement in Sex Work 
AIDS and Behavior  2009;13(5):902-913.
This study examined the HIV risk behaviors and life experiences of 151 transgender female youth, ages 15–24, in Los Angeles and Chicago. Descriptive analyses and logistic regression modeling were used to identify life factors associated with ever having engaged in sex work. Sixty-seven percent of participants had ever engaged in sex work and 19% self-reported being HIV positive. Many factors were significantly associated with sex work for this sample population. A final multivariate logistic regression model found that lower education status, homelessness, use of street drugs, and perceived social support remained significantly associated with sex work when controlling for other factors. Findings highlight the complex HIV risk environment and suggest a need for sex work initiation research for transgender female youth. HIV prevention efforts for this population need to include broad-based approaches that take into account individual, social, and community-level factors relevant to the lives of transgender female youth.
doi:10.1007/s10461-008-9508-8
PMCID: PMC2756328  PMID: 19199022
Youth; Sex work; HIV; Social support; Transgender female youth
9.  Transgender female youth and sex work: HIV risk and a comparison of life factors related to engagement in sex work 
AIDS and behavior  2009;13(5):902-913.
This study examined the HIV risk behaviors and life experiences of 151 transgender female youth, ages 15–24, in Los Angeles and Chicago. Descriptive analyses and logistic regression modeling were used to identify life factors associated with ever having engaged in sex work. Sixty-seven percent of participants had ever engaged in sex work and 19% self-reported being HIV positive. Many factors were significantly associated with sex work for this sample population. A final multivariate logistic regression model found that lower education status, homelessness, use of street drugs, and perceived social support remained significantly associated with sex work when controlling for other factors. Findings highlight the complex HIV risk environment and suggest a need for sex work initiation research for transgender female youth. HIV prevention efforts for this population need to include broad-based approaches that take into account individual, social, and community-level factors relevant to the lives of transgender female youth.
doi:10.1007/s10461-008-9508-8
PMCID: PMC2756328  PMID: 19199022
youth; sex work; HIV; social support; transgender female youth
10.  Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention 
BACKGROUND
Young men who have sex with men (YMSM) experience disparities in HIV rates and potentially in mental health, substance abuse, and exposure to violence.
PURPOSE
We assessed the extent to which these psychosocial health problems had an additive effect on increasing HIV risk among YMSM.
METHODS
An urban sample of 310 ethnically-diverse YMSM reported on psychosocial health problems, sexual risk behaviors, and HIV status. A count of psychosocial health problems was calculated to test the additive relationship to HIV risk.
RESULTS
The prevalence of psychosocial health problems varied from 23% for regular binge drinking to 34% for experiencing partner violence. Rates of sexual risk behaviors were high and 14% of YMSM reported receiving a HIV+ test result. Psychosocial health problems co-occurred, as evidenced by significant bivariate odds ratios between 12 of the 15 associations tested. Number of psychosocial health problems significantly increased the odds of having multiple anal sex partners (OR = 1.24), unprotected anal sex (OR = 1.42), and an HIV positive status (OR 1.42), after controlling for demographic factors.
CONCLUSIONS
These data suggest the existence of co-occurring epidemics, or “syndemic,” of health problems among YMSM. Disparities exist not only in the prevalence of HIV among YMSM, but also in research to combat the epidemic within this vulnerable population. Future research is needed to identify risk and resiliency factors across the range of health disparities and develop interventions that address this syndemic.
doi:10.1080/08836610701495268
PMCID: PMC2219199  PMID: 17688395

Results 1-10 (10)