Publications by authors named "George Ayala"

41 Publications

Economic, Mental Health, HIV Prevention and HIV Treatment Impacts of COVID-19 and the COVID-19 Response on a Global Sample of Cisgender Gay Men and Other Men Who Have Sex with Men.

AIDS Behav 2021 Feb;25(2):311-321

LGBT Foundation, San Francisco, CA, USA.

There is an urgent need to measure the impacts of COVID-19 among gay men and other men who have sex with men (MSM). We conducted a cross-sectional survey with a global sample of gay men and other MSM (n = 2732) from April 16, 2020 to May 4, 2020, through a social networking app. We characterized the economic, mental health, HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 response, and examined whether sub-groups of our study population are disproportionately impacted by COVID-19. Many gay men and other MSM not only reported economic and mental health consequences, but also interruptions to HIV prevention and testing, and HIV care and treatment services. These consequences were significantly greater among people living with HIV, racial/ethnic minorities, immigrants, sex workers, and socio-economically disadvantaged groups. These findings highlight the urgent need to mitigate the negative impacts of COVID-19 among gay men and other MSM.
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http://dx.doi.org/10.1007/s10461-020-02969-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352092PMC
February 2021

Participatory praxis as an imperative for health-related stigma research.

BMC Med 2019 02 15;17(1):32. Epub 2019 Feb 15.

Uganda Youth Coalition on Adolescent SRHR and HIV, Busia, Uganda.

Background: Participatory praxis is increasingly valued for the reliability, validity, and relevance of research results that it fosters. Participatory methods become an imperative in health-related stigma research, where the constitutive elements of stigma, healthcare settings, and research each operate on hierarchies that push those with less social power to the margins.

Discussion: Particularly for people who are stigmatized, participatory methods balance the scales of equity by restructuring power relationships. As such, participatory praxis facilitates a research process that is responsive to community-identified priorities and creates community ownership of the research, catalyzing policy change at multiple levels and foregrounds, and addresses risks to communities from participating in research. Additionally, through upholding the agency and leadership of communities facing stigma, it can help to mitigate stigma's harmful effects. Health-related stigma research can reduce the health inequities faced by stigmatized groups if funders and institutions require and reward community participation and if researchers commit to reflexive, participatory practices. A research agenda focused on participatory praxis in health-related stigma research could stimulate increased use of such methods.

Conclusion: For community-engaged practice to become more than an ethical aspiration, structural changes in the funding, training, publishing, and tenure processes will be necessary.
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http://dx.doi.org/10.1186/s12916-019-1263-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376721PMC
February 2019

Blue-Ribbon Boys: factors associated with PrEP use, ART use and undetectable viral load among gay app users across six regions of the world.

J Int AIDS Soc 2018 07;21 Suppl 5:e25130

Hornet, San Francisco, CA, USA.

Introduction: Gay social networking apps have grown in popularity among men who have sex with men offering opportunities for rapid and confidential collection of vital data as well as social connection. The goal of our study was to explore factors associated with utilization of pre-exposure prophylaxis (PrEP) and antiretroviral treatment (ART), and self-reported undetectable viral load (UVL) using data collected by the gay social networking app Hornet.

Methods: In 2016, the Global Forum on MSM & HIV (MSMGF) partnered with Hornet, to support an educational initiative called Blue-Ribbon Boys. One aspect of the initiative prompts Hornet users to answer a short series of yes-no questions about their sexual health. Using survey responses, we evaluated factors associated with PrEP and ART use as well as self-reported UVL by fitting separate multivariable generalized estimating equation models.

Results: In total, 16,008 unique Hornet users started the survey, of which 12,126 (76%) provided sufficient data for analyses. Of the 10,774 HIV-negative men, 13% reported PrEP use in the past year. PrEP use was associated with a recent sexually transmitted infection (STI) test or treatment (aOR = 2.19, CI = 1.49 to 3.21); and taking steps to protect oneself from HIV (aOR = 1.41, CI = 1.13 to 1.76). Among HIV-positive Hornet users (n = 1243), ART use was associated with older age (each year increase aOR = 1.02, CI = 1.01 to 1.04), a recent STI test or treatment (aOR = 4.54, CI = 2.65 to 7.78); and awareness of unlikely HIV transmission with UVL (aOR = 1.53, CI = 1.03 to 2.26). UVL was associated with older age (each year increase aOR = 1.03, CI = 1.01 to 1.04), a recent STI test or treatment (aOR = 4.84, CI = 2.74 to 8.55), and awareness of unlikely HIV transmission with UVL (aOR = 1.98, CI = 1.37 to 2.85).

Conclusions: Study findings underscore the importance of STI testing and treatment as well as information about HIV transmissibility for encouraging PrEP and ART use. Our findings also reveal age disparities, which can undermine incidence reduction among gay men. Gay social networking apps can be effectively used for rapid data collection and sexual health promotion with men who have sex with men. STI testing and treatment programmes offer important opportunities for encouraging PrEP and ART use. Information about HIV transmissibility with consistent ART use should be incorporated into prevention messaging tailored to various age groups.
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http://dx.doi.org/10.1002/jia2.25130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055118PMC
July 2018

Population Size Estimation of Gay and Bisexual Men and Other Men Who Have Sex With Men Using Social Media-Based Platforms.

JMIR Public Health Surveill 2018 02 8;4(1):e15. Epub 2018 Feb 8.

Public Policy Office, The Foundation for AIDS Research, Washington, DC, United States.

Background: Gay, bisexual, and other cisgender men who have sex with men (GBMSM) are disproportionately affected by the HIV pandemic. Traditionally, GBMSM have been deemed less relevant in HIV epidemics in low- and middle-income settings where HIV epidemics are more generalized. This is due (in part) to how important population size estimates regarding the number of individuals who identify as GBMSM are to informing the development and monitoring of HIV prevention, treatment, and care programs and coverage. However, pervasive stigma and criminalization of same-sex practices and relationships provide a challenging environment for population enumeration, and these factors have been associated with implausibly low or absent size estimates of GBMSM, thereby limiting knowledge about the dynamics of HIV transmission and the implementation of programs addressing GBMSM.

Objective: This study leverages estimates of the number of members of a social app geared towards gay men (Hornet) and members of Facebook using self-reported relationship interests in men, men and women, and those with at least one reported same-sex interest. Results were categorized by country of residence to validate official size estimates of GBMSM in 13 countries across five continents.

Methods: Data were collected through the Hornet Gay Social Network and by using an a priori determined framework to estimate the numbers of Facebook members with interests associated with GBMSM in South Africa, Ghana, Nigeria, Senegal, Côte d'Ivoire, Mauritania, The Gambia, Lebanon, Thailand, Malaysia, Brazil, Ukraine, and the United States. These estimates were compared with the most recent Joint United Nations Programme on HIV/AIDS (UNAIDS) and national estimates across 143 countries.

Results: The estimates that leveraged social media apps for the number of GBMSM across countries are consistently far higher than official UNAIDS estimates. Using Facebook, it is also feasible to assess the numbers of GBMSM aged 13-17 years, which demonstrate similar proportions to those of older men. There is greater consistency in Facebook estimates of GBMSM compared to UNAIDS-reported estimates across countries.

Conclusions: The ability to use social media for epidemiologic and HIV prevention, treatment, and care needs continues to improve. Here, a method leveraging different categories of same-sex interests on Facebook, combined with a specific gay-oriented app (Hornet), demonstrated significantly higher estimates than those officially reported. While there are biases in this approach, these data reinforce the need for multiple methods to be used to count the number of GBMSM (especially in more stigmatizing settings) to better inform mathematical models and the scale of HIV program coverage. Moreover, these estimates can inform programs for those aged 13-17 years; a group for which HIV incidence is the highest and HIV prevention program coverage, including the availability of pre-exposure prophylaxis (PrEP), is lowest. Taken together, these results highlight the potential for social media to provide comparable estimates of the number of GBMSM across a large range of countries, including some with no reported estimates.
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http://dx.doi.org/10.2196/publichealth.9321DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5824103PMC
February 2018

West Hollywood is Not That Big on Anything But White People: Constructing "Gay Men of Color".

Sociol Q 2017;58(4):721-737. Epub 2017 Aug 7.

Center for AIDS Prevention Studies, University of California, San Francisco.

Rather than a defined endpoint that is waiting to be discovered or developed, racial and sexual identities can be considered social identities which are fluid, malleable, and socially created through a social process that defines what it means to be a member of a social group. This paper expands the work on how social identities are constructed by examining personal anecdotes used by gay men of color to discuss how they come to see themselves as "gay men of color." In doing so, we find that gay men of color use a number of cultural tropes that provide them the framework necessary to structure their experiences within a larger social context of a largely white, heterosexual society. Drawing on these cultural tropes, gay men of color create a social identity that is simultaneously raced and sexed through the use of shared cultural tropes that define what it means to be a member of this group.
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http://dx.doi.org/10.1080/00380253.2017.1354734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5722021PMC
August 2017

Availability and Use of Substance Abuse Treatment Programs Among Substance-Using Men Who Have Sex With Men Worldwide.

Subst Use Misuse 2017 04 31;52(5):666-673. Epub 2017 Jan 31.

d The Global Forum on MSM & HIV , Oakland , California , USA.

Background: Substance use is common among men who have sex with men (MSM) worldwide, and epidemiologic data suggest that alcohol/substance-using MSM are at greater risk for HIV. However, there are scarce data on substance abuse treatment programs (SATPs) for substance-using MSM.

Objectives: We examined proportions of substance use as well as SATP availability and use. We used multivariable regression models, controlling for potential confounders, to examine behavioral and demographic correlates of SATP availability and use.

Methods: This is a cross-sectional study of a multi-region, online sample of substance-using MSM.

Results: In this sample, 75% were substance-using MSM of whom 36% reported at-least-weekly use. Substance use was most prevalent among respondents from Eastern Europe/Central Asia (86%) and Latin America (79%). Among substance-using MSM, 96% and 33% reported alcohol intoxication and other substance use, respectively; 11% reported having high SATP availability; and 5% reported using SATPs. Controlling for global region of origin and age, high SATP availability was associated with high access to HIV risk-reduction education (aOR = 3.19; CI = 1.48-6.89), mental health services (aOR = 2.53; CI = 1.32-4.83), and medical care (aOR = 2.32; CI = 1.12-4.80); less than college-level education (aOR = 0.32; CI = 0.18-0.54); and higher comfort levels with providers (aOR = 1.75; CI = 1.30-2.37). Controlling for substance use frequency and personal income additionally, using SATPs was associated with higher levels of connection to the gay community (aOR = 2.76; CI = 1.22-6.22).

Conclusion: In this global sample of MSM, we found high alcohol intoxication and other substance use proportions. Few substance-using MSM report SATP availability, highlighting the need to develop novel substance use programs outside traditional treatment settings.
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http://dx.doi.org/10.1080/10826084.2016.1253744DOI Listing
April 2017

Will the global HIV response fail gay and bisexual men and other men who have sex with men?

J Int AIDS Soc 2016 21;19(1):21098. Epub 2016 Nov 21.

Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.

Introduction: Gay and bisexual men and other men who have sex with men are among the small number of groups for whom HIV remains uncontrolled worldwide. Although there have been recent and notable decreases in HIV incidence across several countries, prevalence and incidence is consistently higher or rising among men who have sex with men when compared with other groups.

Methods: In 2014, MSMGF (the Global Forum on MSM & HIV) conducted its third biennial Global Men's Health and Rights Study, an international, multilingual, web-based cross-sectional survey of men who have sex with men recruited through online convenience sampling. We tested hypothesized correlates (selected ) of successfully achieving each step along the HIV prevention and treatment continuum by fitting separate generalized estimating equation models adjusted for clustering by country in multivariate analyses. All models controlled for ability to meet basic financial needs, age, healthcare coverage, having a regular provider, region and country-level income.

Results: Higher provider discrimination and sexual stigma were associated with lower odds of perceived access to services, service utilization and virologic suppression. Conversely, accessing services from community-based organizations focused on lesbian, gay, bisexual and transgender people; greater engagement in gay community; and comfort with healthcare providers were associated with higher odds of achieving steps along the prevention and treatment continuum.

Conclusions: To meet accelerated global HIV targets, global leaders must adopt a differentiated and bolder response, in keeping with current epidemiologic trends and community-based research. The HIV-related needs of gay and bisexual men and other men who have sex with men must be addressed openly, quickly and with sufficient resources to support evidence-based, community-led and human rights-affirming interventions at scale.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120409PMC
http://dx.doi.org/10.7448/IAS.19.1.21098DOI Listing
September 2017

Inequities in access to HIV prevention services for transgender men: results of a global survey of men who have sex with men.

J Int AIDS Soc 2016 17;19(3 Suppl 2):20779. Epub 2016 Jul 17.

The Global Forum on MSM & HIV (MSMGF), Oakland, CA, USA.

Introduction: Free or low-cost HIV testing, condoms, and lubricants are foundational HIV prevention strategies, yet are often inaccessible for men who have sex with men (MSM). In the global context of stigma and poor healthcare access, transgender (trans) MSM may face additional barriers to HIV prevention services. Drawing on data from a global survey of MSM, we aimed to describe perceived access to prevention services among trans MSM, examine associations between stigma and access, and compare access between trans MSM and cisgender (non-transgender) MSM.

Methods: The 2014 Global Men's Health and Rights online survey was open to MSM (inclusive of trans MSM) from any country and available in seven languages. Baseline data (n=3857) were collected from July to October 2014. Among trans MSM, correlations were calculated between perceived service accessibility and anti-transgender violence, healthcare provider stigma, and discrimination. Using a nested matched-pair study design, trans MSM were matched 4:1 to cisgender MSM on age group, region, and HIV status, and conditional logistic regression models compared perceived access to prevention services by transgender status.

Results: About 3.4% of respondents were trans men, of whom 69 were included in the present analysis. The average trans MSM participant was 26 to 35 years old (56.5%); lived in western Europe, North America, or Oceania (75.4%); and reported being HIV-negative (98.6%). HIV testing, condoms, and lubricants were accessible for 43.5, 53.6, and 26.1% of trans MSM, respectively. Ever having been arrested or convicted due to being trans and higher exposure to healthcare provider stigma in the past six months were associated with less access to some prevention services. Compared to matched cisgender controls, trans MSM reported significantly lower odds of perceived access to HIV testing (OR=0.57, 95% CI=0.33, 0.98) and condom-compatible lubricants (OR=0.54, 95% CI=0.30, 0.98).

Conclusions: This first look at access to HIV prevention services for trans MSM globally found that most reported inadequate access to basic prevention services and that they were less likely than cisgender MSM to have access to HIV testing and lubricants. Results indicate the need to enhance access to basic HIV prevention services for trans MSM, including MSM-specific services.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4949311PMC
http://dx.doi.org/10.7448/IAS.19.3.20779DOI Listing
August 2017

Reductions in access to HIV prevention and care services are associated with arrest and convictions in a global survey of men who have sex with men.

Sex Transm Infect 2017 Feb 4;93(1):62-64. Epub 2016 Mar 4.

The Global Forum on MSM and HIV (MSMGF), Oakland, California, USA.

Objectives: Men who have sex with men (MSM) are disproportionately impacted by HIV. Criminalisation of homosexuality may impede access to HIV services. We evaluated the effect of the enforcement of laws criminalising homosexuality on access to services.

Methods: Using data from a 2012 global online survey that was published in a prior paper, we conducted a secondary analysis evaluating differences in perceived accessibility to health services (ie, 'how accessible are ____' services) between MSM who responded 'yes'/'no' to: 'have you ever been arrested or convicted for being gay/MSM?'

Results: Of the 4020 participants who completed the study and were included in the analysis, 8% reported ever being arrested or convicted under laws relevant to being MSM. Arrests and convictions were most common in sub-Saharan Africa (23.6% (58/246)), Eastern Europe/Central Asia (18.1% (123/680)), the Caribbean (15% (15/100)), Middle East/North Africa (13.2% (10/76)) and Latin America (9.7% (58/599)). Those arrested or convicted had significantly lower access to sexually transmitted infection treatment (adjusted OR (aOR)=0.81; 95% CI 0.67 to 0.97), condoms (aOR=0.77; 95% CI 0.61 to 0.99) and medical care (aOR=0.70; 95% CI 0.54 to 0.90), compared with other MSM, while accounting for clustering by country and adjusting for age, HIV status, education and country-level income.

Conclusions: Arrests and convictions under laws relevant to being MSM have a strong negative association with access to HIV prevention and care services. Creating an enabling legal and policy environment, and increasing efforts to mitigate antihomosexuality stigma to ensure equitable access to HIV services are needed, along with decriminalisation of homosexuality, to effectively address the public health needs of this population.
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http://dx.doi.org/10.1136/sextrans-2015-052386DOI Listing
February 2017

Substance use and experienced stigmatization among ethnic minority men who have sex with men in the United States.

J Ethn Subst Abuse 2014 ;13(4):430-47

a Center for AIDS Prevention Studies, University of California , San Francisco , California.

Research has documented deleterious effects of racism among ethnic minorities and of homophobia among men who have sex with men (MSM). Less is known about the impact of multiple forms of stigmatization on ethnic minority MSM. This study examined substance use by African American, Asian/Pacific Islander and Latino MSM, and the associations of experienced racism and homophobia from various sources with polydrug use and stimulant drug use. Experienced racism within the general community was associated with higher levels of use; other forms of discrimination were either not associated with polydrug or stimulant use or had more complex relationships with use. Implications for further research and interventions are discussed.
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http://dx.doi.org/10.1080/15332640.2014.958640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235618PMC
July 2015

Potential for conceptual bias in studies of racial disparities in HIV infection.

J Acquir Immune Defic Syndr 2015 Mar;68(3):e42-3

*Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada †The Global Forum on MSM and HIV, Oakland, CA ‡Community Health Systems and the Department of Medicine, University of California San Francisco, San Francisco, CA §San Francisco Department of Public Health, San Francisco, CA ‖The International Center for AIDS Care and Treatment Programs (ICAP) and the Department of Socialmedical Sciences, Mailman School of Public Health, Columbia University, New York, NY.

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http://dx.doi.org/10.1097/QAI.0000000000000388DOI Listing
March 2015

Sexual stigma, criminalization, investment, and access to HIV services among men who have sex with men worldwide.

AIDS Behav 2015 Feb;19(2):227-34

The Global Forum on MSM and HIV (MSMGF), 436 14th Street, Suite 1500, Oakland, CA, 94612, USA,

Globally, HIV disproportionately affects men who have sex with men (MSM). This study explored associations between access to HIV services and (1) individual-level perceived sexual stigma; (2) country-level criminalization of homosexuality; and (3) country-level investment in HIV services for MSM. 3,340 MSM completed an online survey assessing access to HIV services. MSM from over 115 countries were categorized according to criminalization of homosexuality policy and investment in HIV services targeting MSM. Lower access to condoms, lubricants, and HIV testing were each associated with greater perceived sexual stigma, existence of homosexuality criminalization policies, and less investment in HIV services. Lower access to HIV treatment was associated with greater perceived sexual stigma and criminalization. Criminalization of homosexuality and low investment in HIV services were both associated with greater perceived sexual stigma. Efforts to prevent and treat HIV among MSM should be coupled with structural interventions to reduce stigma, overturn homosexuality criminalization policies, and increase investment in MSM-specific HIV services.
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http://dx.doi.org/10.1007/s10461-014-0869-xDOI Listing
February 2015

Sexual stigma, criminalization, investment, and access to HIV services among men who have sex with men worldwide.

AIDS Behav 2015 Feb;19(2):227-34

The Global Forum on MSM and HIV (MSMGF), 436 14th Street, Suite 1500, Oakland, CA, 94612, USA,

Globally, HIV disproportionately affects men who have sex with men (MSM). This study explored associations between access to HIV services and (1) individual-level perceived sexual stigma; (2) country-level criminalization of homosexuality; and (3) country-level investment in HIV services for MSM. 3,340 MSM completed an online survey assessing access to HIV services. MSM from over 115 countries were categorized according to criminalization of homosexuality policy and investment in HIV services targeting MSM. Lower access to condoms, lubricants, and HIV testing were each associated with greater perceived sexual stigma, existence of homosexuality criminalization policies, and less investment in HIV services. Lower access to HIV treatment was associated with greater perceived sexual stigma and criminalization. Criminalization of homosexuality and low investment in HIV services were both associated with greater perceived sexual stigma. Efforts to prevent and treat HIV among MSM should be coupled with structural interventions to reduce stigma, overturn homosexuality criminalization policies, and increase investment in MSM-specific HIV services.
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http://dx.doi.org/10.1007/s10461-014-0869-xDOI Listing
February 2015

Internalized homophobia and reduced HIV testing among men who have sex with men in China.

Asia Pac J Public Health 2014 Mar 18;26(2):118-25. Epub 2014 Feb 18.

1The Global Forum on MSM and HIV, Oakland, CA, USA.

Although previous research has examined barriers and facilitators of HIV testing among men who have sex with men (MSM) in China, few studies have focused on social factors, including homophobia and internalized homophobia. This study utilized data from a global online survey to determine correlates of HIV testing as part of a subanalysis focused on Chinese MSM. Controlling for age, HIV knowledge, number of sexual partners, and other covariates, ever having tested for HIV was significantly correlated with lower internalized homophobia. This study suggests that stigma associated with sexual orientation may serve as a barrier to participation in HIV testing and other health-promoting behaviors.
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http://dx.doi.org/10.1177/1010539514524434DOI Listing
March 2014

Internalized homophobia and reduced HIV testing among men who have sex with men in China.

Asia Pac J Public Health 2014 Mar 18;26(2):118-25. Epub 2014 Feb 18.

1The Global Forum on MSM and HIV, Oakland, CA, USA.

Although previous research has examined barriers and facilitators of HIV testing among men who have sex with men (MSM) in China, few studies have focused on social factors, including homophobia and internalized homophobia. This study utilized data from a global online survey to determine correlates of HIV testing as part of a subanalysis focused on Chinese MSM. Controlling for age, HIV knowledge, number of sexual partners, and other covariates, ever having tested for HIV was significantly correlated with lower internalized homophobia. This study suggests that stigma associated with sexual orientation may serve as a barrier to participation in HIV testing and other health-promoting behaviors.
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http://dx.doi.org/10.1177/1010539514524434DOI Listing
March 2014

Homophobia as a barrier to HIV prevention service access for young men who have sex with men.

J Acquir Immune Defic Syndr 2013 Aug;63(5):e167-70

*HIV Prevention Section, San Francisco Department of Public Health, San Francisco, CA †Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA ‡The Global Forum on MSM & HIV (MSMGF), Oakland, CA §Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY ‖Urban Health Program, RTI International, San Francisco, CA.

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http://dx.doi.org/10.1097/QAI.0b013e318294de80DOI Listing
August 2013

Correlates of sexual risk for HIV among US-born and foreign-born Latino men who have sex with men (MSM): an analysis from the Brothers y Hermanos study.

J Immigr Minor Health 2015 Feb;17(1):47-55

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE Mail Stop E37, Atlanta, GA, 30333, USA,

Little research has been conducted to examine whether correlates of sexual risk vary by nativity among Latino men who have sex with men (MSM). We used cross sectional data collected from 870 Latino MSM recruited with respondent-driven sampling techniques. For each sub-sample (US-born and foreign-born), we assessed the association between each of the potential correlates (substance use, acculturation, social support, and social discrimination) and sexual risk behavior. Illicit drug use was associated with increased odds of sexual risk behavior in both US-born (OR = 2.17, 95% CI 1.17-4.03) and foreign-born (OR = 1.86, 1.14-3.05) subgroups. Multivariate correlates specific to foreign-born men included binge drinking (OR = 1.91, 1.17-3.14), 15 years or longer spent in the US (OR = 1.79, 1.06-3.03) and exposure to social discrimination (OR = 2.02, 1.03-3.99). Given the diversity of Latino MSM, information from research that identifies both common and different HIV risk factors across subgroups of Latino MSM may help better tailor HIV prevention programs.
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http://dx.doi.org/10.1007/s10903-013-9894-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629782PMC
February 2015

Correlates of sexual risk for HIV among US-born and foreign-born Latino men who have sex with men (MSM): an analysis from the Brothers y Hermanos study.

J Immigr Minor Health 2015 Feb;17(1):47-55

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE Mail Stop E37, Atlanta, GA, 30333, USA,

Little research has been conducted to examine whether correlates of sexual risk vary by nativity among Latino men who have sex with men (MSM). We used cross sectional data collected from 870 Latino MSM recruited with respondent-driven sampling techniques. For each sub-sample (US-born and foreign-born), we assessed the association between each of the potential correlates (substance use, acculturation, social support, and social discrimination) and sexual risk behavior. Illicit drug use was associated with increased odds of sexual risk behavior in both US-born (OR = 2.17, 95% CI 1.17-4.03) and foreign-born (OR = 1.86, 1.14-3.05) subgroups. Multivariate correlates specific to foreign-born men included binge drinking (OR = 1.91, 1.17-3.14), 15 years or longer spent in the US (OR = 1.79, 1.06-3.03) and exposure to social discrimination (OR = 2.02, 1.03-3.99). Given the diversity of Latino MSM, information from research that identifies both common and different HIV risk factors across subgroups of Latino MSM may help better tailor HIV prevention programs.
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http://dx.doi.org/10.1007/s10903-013-9894-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629782PMC
February 2015

Dimensions of racism and their impact on partner selection among men of colour who have sex with men: understanding pathways to sexual risk.

Cult Health Sex 2013 10;15(7):836-50. Epub 2013 May 10.

Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, USA.

While many studies have established the relationship between experiences of racism and sexual risk among men of colour who have sex with men, the pathways by which this occurs are underdeveloped. To address this gap, we must better investigate the lived realities of racism in the gay community. In this study, we had the unique opportunity to examine experiences of racism among African American, Asian/Pacific Islander and Latino men who have sex with men living in Los Angeles through focus groups and individual in-depth interviews. We found three themes of racism: exclusion from West Hollywood and the mainstream gay community, sexual rejection based on race/ethnicity and sexual stereotypes. There were differences across the three racial groups in the experiences of each theme, however. We then considered how racism impacted partner selection and found that race played a salient role in determining power differentials within mixed-race partnerships. Finally, we discussed several future areas for research that can better establish pathways between racism and sexual risk.
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http://dx.doi.org/10.1080/13691058.2013.785025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742646PMC
April 2014

Experiences of discrimination and their impact on the mental health among African American, Asian and Pacific Islander, and Latino men who have sex with men.

Am J Public Health 2013 May 14;103(5):868-74. Epub 2013 Mar 14.

Center for AIDS Prevention Studies, University of California, San Francisco, CA 94105, USA.

Objectives: We examined the associations between specific types and sources of discrimination and mental health outcomes among US racial/ethnic minority men who have sex with men (MSM) and how these associations varied by race/ethnicity.

Methods: A chain-referral sample of 403 African American, 393 Asian and Pacific Islander (API), and 400 Latino MSM recruited in Los Angeles County, California completed a standardized questionnaire. Data were obtained from the Ethnic Minority Men's Health Study from May 2008 to October 2009.

Results: Past-year experiences of racism within the general community and perceived homophobia among heterosexual friends were positively associated with depression and anxiety. Past-year homophobia experienced within the general community was also positively associated with anxiety. These statistically significant associations did not vary across racial/ethnic groups. The positive association of perceived racism within the gay community with anxiety differed by race/ethnicity, and was statistically significant only for APIs. Perceived homophobia within the family was not associated with either depression or anxiety.

Conclusions: Higher levels of experiences of discrimination were associated with psychological distress among MSM of color. However, specific types and sources of discrimination were differentially linked to negative mental health outcomes among African American, API, and Latino MSM.
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http://dx.doi.org/10.2105/AJPH.2012.301052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625493PMC
May 2013

Access to Basic HIV-Related Services and PrEP Acceptability among Men Who Have sex with Men Worldwide: Barriers, Facilitators, and Implications for Combination Prevention.

J Sex Transm Dis 2013 8;2013:953123. Epub 2013 Jul 8.

Urban Health Program, RTI International, San Francisco, CA, USA.

Introduction. Men who have sex with men (MSM) are disproportionately impacted by HIV globally. Easily accessible combination HIV prevention strategies, tailored to the needs of MSM, are needed to effectively address the AIDS pandemic. Methods and Materials. We conducted a cross-sectional study among MSM (n = 3748) from 145 countries from April to August 2012. Using multivariable random effects models, we examined factors associated with acceptability of preexposure prophylaxis (PrEP) and access to condoms, lubricants, HIV testing, and HIV treatment. Results. Condoms and lubricants were accessible to 35% and 22% of all respondents, respectively. HIV testing was accessible to 35% of HIV-negative respondents. Forty-three percent of all HIV-positive respondents reported that antiretroviral therapy was easily accessible. Homophobia, outness, and service provider stigma were significantly associated with reduced access to services. Conversely, community engagement, connection to gay community, and comfort with service providers were associated with increased access. PrEP acceptability was associated with lower PrEP-related stigma, less knowledge about PrEP, less outness, higher service provider stigma, and having experienced violence for being MSM. Conclusions. Ensuring HIV service access among MSM will be critical in maximizing the potential effectiveness of combination approaches, especially given the interdependence of both basic and newer interventions like PrEP. Barriers and facilitators of HIV service access for MSM should be better understood and addressed.
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http://dx.doi.org/10.1155/2013/953123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4437423PMC
August 2015

From personal survival to public health: community leadership by men who have sex with men in the response to HIV.

Lancet 2012 Jul 20;380(9839):400-10. Epub 2012 Jul 20.

Centre for the Development of People, Lilongwe, Malawi.

Community leadership and participation by gay men and men who have sex with men (MSM) have been central to the response to HIV since the beginning of the epidemic. Through a wide array of actions, engagement of MSM has been important in the protection of communities. The connection between personal and community health as drivers of health advocacy continue to be a powerful element. The passion and urgency brought by MSM communities have led to the targeting and expansion of HIV and AIDS research and programming, and have improved the synergy of health and human rights, sustainability, accountability, and health outcomes for all people affected by HIV. MSM are, however, frequently excluded from the evidence-based services that they helped to develop, despite them generally being the most effective actors in challenging environments. Without MSM community involvement, government-run health programmes might have little chance of effectively reaching communities or scaling up interventions to lessen, and ultimately end, the HIV pandemic.
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http://dx.doi.org/10.1016/S0140-6736(12)60834-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805044PMC
July 2012

Using GRADE methodology for the development of public health guidelines for the prevention and treatment of HIV and other STIs among men who have sex with men and transgender people.

BMC Public Health 2012 May 28;12:386. Epub 2012 May 28.

Department of Medicine, State University of New York at Buffalo, NY, USA.

Background: The World Health Organization (WHO) Department of HIV/AIDS led the development of public health guidelines for delivering an evidence-based, essential package of interventions for the prevention and treatment of HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender people in the health sector in low- and middle-income countries. The objective of this paper is to review the methodological challenges faced and solutions applied during the development of the guidelines.

Methods: The development of the guidelines followed the WHO guideline development process, which utilizes the GRADE approach. We identified, categorized and labeled the challenges identified in the guidelines development process and described the solutions through an interactive process of in-person and electronic communication.

Results: We describe how we dealt with the following challenges: (1) heterogeneous and complex interventions; (2) paucity of trial data; (3) selecting outcomes of interest; (4) using indirect evidence; (5) integrating values and preferences; (6) considering resource use; (7) addressing social and legal barriers; (8) wording of recommendations; and (9) developing global guidelines.

Conclusion: We were able to successfully apply the GRADE approach for developing recommendations for public health interventions. Applying the general principles of the approach while carefully considering specific challenges can enhance both the process and the outcome of guideline development.
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http://dx.doi.org/10.1186/1471-2458-12-386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490932PMC
May 2012

Structure, agency, and sexual development of Latino gay men.

J Sex Res 2013 21;50(3-4):392-400. Epub 2012 Mar 21.

Urban Health Program, RTI International, San Francisco, CA 94104, USA.

There is a high prevalence of childhood sexual abuse and HIV among Latino gay men, with limited proven HIV prevention interventions. This study used qualitative methods to explicate earlier findings showing differential health outcomes among Latino gay men who had no sex, voluntary, or forced sex before age 16. Analyses of in-depth interviews with 27 Latino gay men revealed that structural factors in childhood contribute to their developing sexuality by enhancing or inhibiting a sense of agency. Agency is essential for making decisions that are in line with their intentions to have healthy sexual lives. Findings suggest that interventions should focus on developing a sense of sexual agency among Latino gay men by (a) increasing their recognition of structural factors that contribute to feelings of worthlessness in order to relocate internalized blame and homophobia to external structural forces, (b) facilitating awareness of the social structural oppressions that lead to psychological and sexual risk in order to enhance their options for sexual health, and (c) shifting from individually focused constructions of sexual health to those that consider the structural factors that reduce agency and contribute to diminished sexual health among Latino gay men.
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http://dx.doi.org/10.1080/00224499.2011.648028DOI Listing
April 2014

Structure, agency, and sexual development of Latino gay men.

J Sex Res 2013 21;50(3-4):392-400. Epub 2012 Mar 21.

Urban Health Program, RTI International, San Francisco, CA 94104, USA.

There is a high prevalence of childhood sexual abuse and HIV among Latino gay men, with limited proven HIV prevention interventions. This study used qualitative methods to explicate earlier findings showing differential health outcomes among Latino gay men who had no sex, voluntary, or forced sex before age 16. Analyses of in-depth interviews with 27 Latino gay men revealed that structural factors in childhood contribute to their developing sexuality by enhancing or inhibiting a sense of agency. Agency is essential for making decisions that are in line with their intentions to have healthy sexual lives. Findings suggest that interventions should focus on developing a sense of sexual agency among Latino gay men by (a) increasing their recognition of structural factors that contribute to feelings of worthlessness in order to relocate internalized blame and homophobia to external structural forces, (b) facilitating awareness of the social structural oppressions that lead to psychological and sexual risk in order to enhance their options for sexual health, and (c) shifting from individually focused constructions of sexual health to those that consider the structural factors that reduce agency and contribute to diminished sexual health among Latino gay men.
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http://dx.doi.org/10.1080/00224499.2011.648028DOI Listing
April 2014

Sex drugs, peer connections, and HIV: Use and risk among African American, Latino, and Multiracial young men who have sex with men (YMSM) in Los Angeles and New York.

J Gay Lesbian Soc Serv 2011 Jan;23(2):271-295

Department of Sociology, University of California - Los Angeles, CA.

African American and Latino young men who have sex with men are at high risk for HIV infection. We administered brief intercept surveys (N=416) at 18 Black and Latino gay pride events in Los Angeles and New York in 2006 and 2007. Ordinal logistic regressions were used to model the effects of substance use during sex, peer connectedness, relationship status, and homelessness on condom use. Alcohol use, crystal use, homelessness, and having a primary relationship partner were negatively associated with condom use, while peer connectedness and marijuana use during sex were positively associated with condom use. Implications for service providers and future research are discussed.
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http://dx.doi.org/10.1080/10538720.2011.560100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3126154PMC
January 2011

Homophobia and racism experienced by Latino men who have sex with men in the United States: correlates of exposure and associations with HIV risk behaviors.

AIDS Behav 2012 Apr;16(3):724-35

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE Mail Stop E37, Atlanta, GA 30333, USA.

Using cross-sectional data collected from 1081 Latino men who have sex with men (MSM) recruited with respondent-driven sampling (RDS) techniques from Los Angeles and New York, we examined the extent to which Latino MSM reported exposure to social discrimination (i.e., experienced both homophobia and racism, homophobia only, racism only, or neither homophobia nor racism). More than 40% of respondents experienced both homophobia and racism in the past 12 months. Los Angeles participants, those with lower income, and those who reported being HIV-positive were more likely to report experiencing both types of social discrimination. Adjusting for potential confounders, men exposed to both homophobia and racism were more likely than men exposed to neither form of discrimination to report unprotected receptive anal intercourse with a casual sex partner (AOR = 1.92, 95% CI, 1.18-3.24) and binge drinking (AOR = 1.42, 95% CI, 1.02-1.98). Our findings suggest the presence of a syndemic of adverse social experiences and call for more intervention research to address both homophobia and racism experienced among Latino MSM in the United States.
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http://dx.doi.org/10.1007/s10461-011-9967-1DOI Listing
April 2012

Strategies for managing racism and homophobia among U.S. ethnic and racial minority men who have sex with men.

AIDS Educ Prev 2011 Apr;23(2):145-58

Center for AIDS Prevention Studies, University of California, San Francisco, 94105, USA.

Despite widespread recognition that experiences of social discrimination can lead to poor physical and mental health outcomes for members of minority groups, little is known about how U.S. ethnic minority men who have sex with men (MSM) manage their experiences of racism and homophobia. We conducted six focus group discussions (n = 50) and 35 in-depth interviews with African American, Latino, and Asian and Pacific Islander MSM (aged 18 or older) recruited in Los Angeles. This process revealed five strategies that MSM of color employed in order to mitigate the impact of racism and homophobia. To minimize opportunities for stigmatization, men used (a) concealment of homosexuality and (b) disassociation from social settings associated with stigmatization. To minimize the impact of experienced stigma, men (c) dismissed the stigmatization and (d) drew strength and comfort from external sources. Men also actively countered stigmatization by (e) direct confrontation. More research is needed to understand the efficacy of these coping strategies in mitigating negative health consequences of stigmatization and discrimination.
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http://dx.doi.org/10.1521/aeap.2011.23.2.145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083124PMC
April 2011

Internet sex ads for MSM and partner selection criteria: the potency of race/ethnicity online.

J Sex Res 2010 Nov;47(6):528-38

Center for Aids Prevention Studies, University of California, San Francisco.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065858PMC
http://dx.doi.org/10.1080/00224490903244575DOI Listing
November 2010