Publications by authors named "John A Schneider"

146 Publications

Community-clinic linkages for promoting HIV prevention: organizational networks for PrEP client referrals and collaborations.

AIDS Care 2021 Jun 4:1-9. Epub 2021 Jun 4.

School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.

Community-clinic linkages may help communities increase HIV pre-exposure prophylaxis (PrEP) uptake. Referrals from community-based organizations may be particularly important for linking Black men who have sex with men (MSM) to PrEP. This study describes PrEP referral and HIV/STI prevention networks among organizations that serve MSM in Houston, TX (= 40), and Chicago, IL (= 28), and compares network positions of organizations based on percentage of Black/African American clients. A majority of organizations conducted PrEP awareness/promotion activities, but fewer made PrEP referrals, with little overlap between the collaboration and referral networks. The networks tended to have a densely connected core group of organizations and more a peripheral group of organizations linking into the core with relatively few times among themselves; this core/periphery structure is efficient, but vulnerable to disruptions. The percentage of Black/African American clients organizations served was not related to most measures of network centrality. However, in Houston's collaboration network, higher Black-serving organizations tended not to hold as influential positions for controlling communications or flows of resources. The findings indicate a potential to leverage collaborations into PrEP referral pathways to enhance PrEP promotion efforts and identify opportunities to address racial disparities in PrEP uptake.
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http://dx.doi.org/10.1080/09540121.2021.1936445DOI Listing
June 2021

Shared decision making for HIV pre-exposure prophylaxis (PrEP) with black transgender women.

Cult Health Sex 2021 May 13:1-20. Epub 2021 May 13.

Section of Infectious Diseases, University of Chicago, Chicago, IL, USA.

Shared decision making is a collaborative process intended to develop a treatment plan that considers both the patient's preferences and the health provider's medical recommendations. It is one approach to reducing healthcare disparities by improving patient-provider communication and subsequent health outcomes. This study examines shared decision making about HIV pre-exposure prophylaxis (PrEP) with Black transgender women in Chicago, Illinois, USA, given high prevalence of HIV and disparities in PrEP use. Black transgender women were recruited online and in-person to participate in semi-structured interviews ( = 24) and focus groups (2;  = 14 total), conducted between 2016 and 2017. Iterative thematic content analysis took place. Analysis revealed that internalised transphobia and racism, combined with stigma from service providers, prevented disclosure of gender and sexual identity to providers. Stigma about PrEP as it relates to Black transgender women results in stereotype threat, which undermines patient-provider trust and deters shared decision making for PrEP. Shared decision making promotes cultural competence and humility and builds trust within the patient-provider relationship, leading to better communication and less stigma. The involvement of peers may be one way to mitigate stigma for Black transgender women around PrEP, promote cultural competence within organisations, and empower engagement in shared decision making for HIV prevention.
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http://dx.doi.org/10.1080/13691058.2021.1909142DOI Listing
May 2021

Sexual Identity, Sexual Behavior and Pre-exposure Prophylaxis in Black Cisgender Sexual Minority Men: The N2 Cohort Study in Chicago.

AIDS Behav 2021 Apr 14. Epub 2021 Apr 14.

Columbia Spatial Epidemiology Lab, Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 729, New York, NY, 10032, USA.

This study investigated sexual identity and behavior and their potential associations with PrEP use and attitudes in cisgender Black gay and bisexual men. A total of N = 173 (mean age 25.2) participants from the Neighborhoods and Networks (N2) Study in Chicago were included. Of these, 104 were gay-identified and reported sex with men only (GSMO), 26 were gay-identified and reported sex with men and women (GSMW), 8 were bisexual-identified and reported sex with men only (BSMO), and 35 were bisexual-identified and reported sex with men and women (BSMW). Reporting sex with men and women in the past 6 months, RR = 0.39, 95% CI [0.17, 0.89], identifying as bisexual, RR = 0.52, 95% CI [0.29, 0.92], and the combination of the two, RR = 0.24, 95% CI [0.07, 0.76] were significantly associated with lower rates of current oral PrEP use. Black bisexual-identifying men who reported sex with men and women were significantly more likely to have discontinued oral PrEP, RR = 2.50, 95% CI [1.14, 5.50], than Black gay-identified men who reported sex with men only. Participants who had not used oral PrEP before reported lower levels of interest in long-acting injectable PrEP than those who were currently using oral PrEP, RR = 0.56, 95% CI [0.40, 0.79]. No other significant differences were found. Overlooking the combination of sexual identity and behavior may mischaracterize PrEP rates and miss uniquely vulnerable subgroups. Black gay and bisexual men who had not used oral PrEP may be particularly disinterested in long-acting injectable PrEP.
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http://dx.doi.org/10.1007/s10461-021-03246-4DOI Listing
April 2021

Association of Social Network Characteristics With Cardiovascular Health and Coronary Artery Calcium in South Asian Adults in the United States: The MASALA Cohort Study.

J Am Heart Assoc 2021 Apr 24;10(7):e019821. Epub 2021 Mar 24.

Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.

Background South Asian adults have worse cardiovascular health (CVH) and more coronary artery calcium compared with other race/ethnicities. The impact of the social environment has not been examined as a potential driver of CVH or coronary artery calcium in this population. We evaluated associations of social network characteristics with CVH and coronary artery calcium in South Asian American adults to inform strategies for CVH promotion in this at-risk population. Methods and Results Using data from the MASALA (Mediators of Atherosclerosis in South Asians Living in America) cohort study, multinomial and multivariable logistic regression were used to evaluate associations of participant social network size and density, proportion of network who are kin or South Asian ethnicity and reported health of participant's identified social network members ("alters"), with participant CVH and presence of coronary artery calcium. The 699 MASALA participants included were mean age 59.2 (SD, 9.2) years and 42.9% women. After adjustment, a 1-person larger social network size was associated with 13% higher odds of ideal CVH (odds ratio [OR], 1.13; 95% CI, 1.01-1.27). Reporting an alter with high blood pressure was associated with lower odds of ideal CVH (OR, 0.51; 95% CI, 0.29-0.88), and reporting an alter with high cholesterol was associated with lower odds of ideal CVH (OR, 0.54; 95% CI, 0.30-0.94). Conclusions Social network characteristics are associated with CVH in South Asian American adults. Engaging social networks may help promote CVH in this population.
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http://dx.doi.org/10.1161/JAHA.120.019821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174337PMC
April 2021

Reducing Opioid Mortality in Illinois (ROMI): A case management/peer recovery coaching critical time intervention clinical trial protocol.

J Subst Abuse Treat 2021 Mar 11:108348. Epub 2021 Mar 11.

Crown Family School of Social Work, Policy, and Practice, Department of Public Health Sciences, University of Chicago Urban Labs, Biological Sciences Collegiate Division, 969 East 60th St, Chicago, IL 60637, United States. Electronic address:

Individuals with a history of opioid use are disproportionately represented in Illinois jails and prisons and face high risks of overdose and relapse at community reentry. Case management and peer recovery coaching are established interventions that may be leveraged to improve linkage to substance use treatment and supportive services during these critical periods of transition. We present the protocol for the Reducing Opioid Mortality in Illinois (ROMI), a type I hybrid effectiveness-implementation randomized trial of a case management, peer recovery coaching and overdose education and naloxone distribution (CM/PRC + OEND) critical time intervention (CTI) compared to OEND alone. The CM/PRC + OEND is a novel, 12-month intervention that involves linkage to substance use treatment and support for continuity of care, skills building, and navigation and engagement of social services that will be implemented using a hub-and-spoke model of training and supervision across the study sites. At least 1000 individuals released from jails and prisons spanning urban and rural settings will be enrolled. The primary outcome is engagement in medication for opioid use disorder. Secondary outcomes include health insurance enrollment, mental health service engagement, and re-arrest/recidivism, parole violation, and/or reincarceration. Mixed methods will be used to evaluate process and implementation outcomes including fidelity to, barriers to, facilitators of, and cost of the intervention. Videoconferencing and other remote processes will be leveraged to modify the protocol for safety during the COVID-19 pandemic. Results of the study may improve outcomes for vulnerable persons at the margin of behavioral health and the criminal legal system.
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http://dx.doi.org/10.1016/j.jsat.2021.108348DOI Listing
March 2021

Sleep health among transgender women of color in New York City: Preliminary analyses of interim baseline data from the TURNNT study cohort.

Sleep Health 2021 Apr 19;7(2):153-154. Epub 2021 Feb 19.

Mailman School of Public Health, Columbia University, New York City, New York, USA.

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http://dx.doi.org/10.1016/j.sleh.2021.01.005DOI Listing
April 2021

Methodological synthesis of Bayesian phylodynamics, HIV-TRACE, and GEE: HIV-1 transmission epidemiology in a racially/ethnically diverse Southern U.S. context.

Sci Rep 2021 Feb 8;11(1):3325. Epub 2021 Feb 8.

Division of Disease Prevention and Control, Houston Health Department, Houston, TX, USA.

This study introduces an innovative methodological approach to identify potential drivers of structuring HIV-1 transmission clustering patterns between different subpopulations in the culturally and racially/ethnically diverse context of Houston, TX, the largest city in the Southern United States. Using 6332 HIV-1 pol sequences from persons newly diagnosed with HIV during the period 2010-2018, we reconstructed HIV-1 transmission clusters, using the HIV-TRAnsmission Cluster Engine (HIV-TRACE); inferred demographic and risk parameters on HIV-1 transmission dynamics by jointly estimating viral transmission rates across racial/ethnic, age, and transmission risk groups; and modeled the degree of network connectivity by using generalized estimating equations (GEE). Our results indicate that Hispanics/Latinos are most vulnerable to the structure of transmission clusters and serve as a bridge population, acting as recipients of transmissions from Whites (3.0 state changes/year) and from Blacks (2.6 state changes/year) as well as sources of transmissions to Whites (1.8 state changes/year) and to Blacks (1.2 state changes/year). There were high rates of transmission and high network connectivity between younger and older Hispanics/Latinos as well as between younger and older Blacks. Prevention and intervention efforts are needed for transmission clusters that involve younger racial/ethnic minorities, in particular Hispanic/Latino youth, to reduce onward transmission of HIV in Houston.
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http://dx.doi.org/10.1038/s41598-021-82673-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870963PMC
February 2021

Perceptions of quality and safety in cannabis acquisition amongst young gay and bisexual men living with HIV/AIDS who use cannabis: Impact of legalisation and dispensaries.

Int J Drug Policy 2021 Feb 9;88:103035. Epub 2020 Dec 9.

Chicago Center for HIV Elimination, University of Chicago, 1525 E 55th st, Chicago, IL, 60615, United States; Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, United States; Department of Public Health Sciences, University of Chicago, 5841 S Maryland Ave Chicago, IL, 60637, United States.

Background: Upwards of 35% of young gay and bisexual men living with HIV report daily use of cannabis in the U.S. The effects of legalisation of recreational and medical cannabis on the acquisition of cannabis products amongst a group with such high prevalence of use is largely unknown.

Methods: We investigated potential effects of recent legalisation and changes in distribution venues/networks in U.S. jurisdictions (Denver and Chicago) with different legal statuses regarding medical and recreational cannabis. We conducted semi-structured interviews with 30 young gay and bisexual men living with HIV recruited from adolescent HIV clinics and service sites in the two cities.

Results: Findings indicate four domains in which the acquisition of cannabis from medical or recreational dispensaries was differentiated by participants from acquisition from illicit drug distribution networks: quality of information, perceived quality of products, safety of acquisition, and safety of products. Some participants expressed reservations in becoming involved with requirements for accessing legal distribution of medical and recreational cannabis.

Conclusions: Our findings indicate that young men living with HIV in Denver perceive benefits from legalisation of cannabis in terms of quality of information and products and safety of acquisition for a range of medical, therapeutic, and recreational uses. Participants in Chicago report mixed levels of knowledge of potential benefits through the medical cannabis dispensaries in their area, and continue to be exposed to safety risks associated with street-based acquisition. Concerns regarding institutional involvement in medical cannabis registries and dispensaries may inhibit the uptake of legal means of acquisition in sub-populations of young men living with HIV.
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http://dx.doi.org/10.1016/j.drugpo.2020.103035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005436PMC
February 2021

A Pragmatic Randomized Controlled Trial to Increase PrEP Uptake for HIV Prevention: 55-Week Results From PrEPChicago.

J Acquir Immune Defic Syndr 2021 Jan;86(1):31-37

University of Chicago, Chicago, IL.

Objectives: We tested preliminary efficacy of a peer change agent type I network intervention to increase pre-exposure prophylaxis (PrEP) linkage to care among network members connected to young Black men who have sex with men.

Design: Parent study is a pragmatic randomized controlled trial with 110 weeks of total follow-up. Interim midpoint analyses are performed here using participant data before crossover assignment at 55 weeks.

Methods: We randomly assigned 423 participants in Chicago to receive the network intervention, an opinion leader workshop with telephonic booster sessions, versus a time-matched control from 2016 to 2018. The consolidated surrogate outcome was PrEP referral and linkage to clinical care among network members connected to study participants and was collected from independent administrative data.

Results: Each study participant in the trial (n = 423) had on average 1822 network contacts who could be eligible for PrEP referral and linkage. During the 55-week observation period, PrEP referral was most likely to occur within 3 days of an intervention session compared to control [odds ratio (OR) 0.07 (0.02-0.013); P = 0.007] resulting in 1-2 referrals of network members per session. Network members with referral or linkage were more likely to be connected to study participants in the intervention arm than the control condition [aOR 1.50 (1.09-2.06); P = 0.012].

Conclusions: A peer change agent type I network intervention is preliminarily effective at diffusing PrEP through a network of individuals highly susceptible to HIV over 55 weeks. This low-intensity intervention demonstrated network-level impact among populations that have experienced limited PrEP care engagement in the United States.
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http://dx.doi.org/10.1097/QAI.0000000000002518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722461PMC
January 2021

The last Black man with HIV in San Francisco: the potential role of gentrification on HIV getting to zero achievements.

Lancet HIV 2020 12;7(12):e853-e856

Department of Medicine, University of Chicago, Chicago, IL, USA; Department of Public Health Sciences, University of Chicago, Chicago, IL, USA; Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.

San Francisco was the first city in the USA to develop a Getting to Zero HIV elimination strategy. The cause of decreased HIV incidence has been attributed to the use of biomedical prevention methods, such as pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP). These strategies have benefitted White men who have sex with men (MSM), whose population has increased over the past decade. However, Black MSM in San Francisco continue to have higher HIV incidence and outmigration rates. We posit that the declining overall HIV incidence, including among White MSM, is not only explained by the use of TaSP and PrEP, but is also due to the declining Black population and rising HIV incidence among Black MSM, who have historically been more likely to acquire HIV due to structural, racial, and criminal justice-related factors than have White MSM.
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http://dx.doi.org/10.1016/S2352-3018(20)30250-2DOI Listing
December 2020

Associations Between Experienced HIV Stigma, Resulting Consequences, and the HIV Care Continuum: Moderating Effects of Two Resilience Characteristics Among Persons Living with HIV (PLWH) in Louisiana.

J Racial Ethn Health Disparities 2020 Nov 19. Epub 2020 Nov 19.

New Orleans Regional AIDS Planning Council, New Orleans, LA, USA.

Introduction: HIV-related stigma continues to serve as a major barrier to HIV care. HIV stigma reduction interventions are urgently needed to promote and protect the health of persons living with HIV (PLWH). Resilience has been identified as a potential leverage to mitigate the impact of HIV-related stigma among PLWH.

Methods: We examined whether two resilience measures (i.e., social support and resilience assets and resources [RAR]) moderated the relationship between experienced HIV stigma and the HIV care continuum as well as how they moderated the relationship between the consequences of experienced HIV stigma (CES) and the HIV care continuum among 300 PLWH in Louisiana. Separate bootstrapping analyses were conducted to test for evidence of moderated moderation.

Results: Most participants were Black (79%) and had been living with HIV for 10 years or more. A relatively high sample of men who have sex with men (MSM) were enrolled (37%). The most common CES were depression (67%). The most common manifestation of experienced HIV stigma was being gossiped about (53%). Participants reported moderate levels of social support. In terms of RAR, most participants (71%) reported that they knew of groups that could support them in responding to experienced HIV stigma. After adjusting for potential covariates, social support and RAR both significantly moderated the relationship between experienced HIV stigma and length of time since their last HIV care visit, B(SE) = .003(.001), p = .03. At high levels of RAR and high levels of social support, those with higher levels of experienced HIV stigma reported a longer length of time since their last HIV care visit than those who reported lower levels of experienced HIV stigma (B(SE) = .17(.04), p < .001). RAR moderated the relationship between social support and HIV care, B(SE) = .01(.004), p < .001. Those who experienced greater CES reported a longer length of time since their last doctor's visit B(SE) = .04(.02), p < .05. Experienced HIV stigma was not significantly associated with viral load results. However, social support significantly moderated the relationship between experienced stigma and viral load results. At higher levels of social support, those who experienced lower levels of stigma were more likely to report an undetectable viral load than those who had higher levels of stigma, B(SE) = - .13(.03), p < .001. Finally, both RAR and social support moderated the relationship between CES and viral load results. Those who reported higher levels of RAR B(SE) = - .07(.02), p < .001, and social support, B(SE) = - .02(.01), p < .05, also reported having an undetectable viral load at most recent HIV care visit. CES was not significantly related to reporting an undetectable viral load (p = .61).

Conclusions: Enrolled PLWH already have some level of resilience which plays an important protective role within the context of the HIV care continuum up to a certain extent. Interventions to enhance the RAR and social support components may be useful especially among MSM and persons who have been living with HIV for a shorter period of time.
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http://dx.doi.org/10.1007/s40615-020-00925-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676401PMC
November 2020

Same-day prescribing of daily oral pre-exposure prophylaxis for HIV prevention.

Lancet HIV 2021 02 28;8(2):e114-e120. Epub 2020 Oct 28.

Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Pre-exposure prophylaxis (PrEP) is highly effective in reducing HIV transmission but remains underutilised globally. Same-day PrEP prescribing and medication provision is an emerging implementation approach. The experiences of the three same-day PrEP programmes support the feasibility of the approach. Key elements of safe and effective same-day PrEP programmes include the ability to order laboratory tests at the time of the clinical visit and the ability to contact patients when laboratory results are available. Same-day PrEP has the potential to alleviate the attrition seen in usual care between initial evaluation and receipt of a PrEP prescription. A widespread application of same-day prescribing will be needed to assess its effect on PrEP usage.
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http://dx.doi.org/10.1016/S2352-3018(20)30256-3DOI Listing
February 2021

Comparison of effectiveness and cost for different HIV screening strategies implemented at large urban medical centre in the United States.

J Int AIDS Soc 2020 10;23(10):e25554

Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.

Introduction: Incident HIV infections persist in the United States (U.S.) among marginalized populations. Targeted and cost-efficient testing strategies can help in reaching HIV elimination. This analysis compares the effectiveness and cost of three HIV testing strategies in a high HIV burden area in the U.S. in identifying new HIV infections.

Methods: We performed a cost analysis comparing three HIV testing strategies in Chicago: (1) routine screening (RS) in an inpatient and outpatient setting, (2) modified partner services (MPS) among networks of the recently HIV infected and diagnosed, and (3) a respondent drive sampling (RDS)-based social network (SN) approach targeting young African-American men who have sex with men. All occurred at the same academic medical centre during the following times: routine testing, 2011 to 2016; MPS, 2013 to 2016; SN: 2013 to 2014. Costs were in 2016 dollars and included personnel, HIV testing, training, materials, overhead. Outcomes included cost per test, HIV-positive test and new diagnosis. Sensitivity analyses were performed to assess the impact of population demographics.

Results: The RS programme completed 57,308 HIV tests resulting in 360 (0.6%) HIV-positive tests and 165 new HIV diagnoses (0.28%). The MPS completed 146 HIV tests, resulting in 79 (54%) HIV-positive tests and eight new HIV diagnoses (5%). The SN strategy completed 508 HIV tests, resulting in 210 (41%) HIV-positive tests and 37 new HIV diagnoses (7.2%). Labour accounted for the majority of costs in all strategies. The estimated cost per new HIV diagnosis was $16,773 for the RS programme, $61,418 for the MPS programme and $15,683 for the SN testing programme. These costs were reduced for the RS and MPS strategies in sensitivity analyses limiting testing efficacy to the highest prevalence patient populations ($2,841 and $33,233 respectively).

Conclusions: The SN strategy yielded the highest proportion of new diagnoses, followed closely by the MPS programme. Both the SN strategy and RS programme were comparable in the cost per new diagnosis. A simultaneous approach that consists of RS in combination with SN testing may be most effective for identifying new HIV infections in settings with heterogeneous epidemics with both high rates of HIV prevalence and HIV testing.
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http://dx.doi.org/10.1002/jia2.25554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594703PMC
October 2020

Embedding a Linkage to Preexposure Prophylaxis Care Intervention in Social Network Strategy and Partner Notification Services: Results From a Pilot Randomized Controlled Trial.

J Acquir Immune Defic Syndr 2021 Feb;86(2):191-199

Department of Medicine, University of Chicago, Chicago, IL.

Background: Increased preexposure prophylaxis (PrEP) uptake among black men who have sex with men and black transgender women (BMSM/TW) is needed to end the HIV epidemic. Embedding a brief intervention in network services that engage individuals in HIV transmission networks for HIV/ sexually transmitted infections testing may be an important strategy to accelerate PrEP uptake.

Setting: Partner Services PrEP study is a pilot, randomized, control trial to improve linkage to PrEP care among BMSM/TW presenting for network services in Chicago, IL, from 2015 to 2017.

Methods: BMSM/TW (N = 146) aged 18-40 years were recruited from network services (partners services and social network strategy services). Intervention participants developed an individualized linkage plan based on the information-motivation-behavioral skills model and received minibooster sessions. Control participants received treatment as usual. Sociodemographic, behavioral, and clinical factors were examined at baseline and 3- and 12-month postintervention. Intent-to-treat analyses examined linkage to PrEP care within 3-month postintervention (primary outcome). Secondary outcomes were PrEP initiation, time to linkage to PrEP care, and time to PrEP initiation.

Results: Compared with control participants, a significantly greater proportion of the intervention participants were linked to PrEP care within 3 months (24% vs. 11%; P = 0.04) and initiated PrEP (24% vs. 11%; P = 0.05). Among those linked to PrEP care within the study period, intervention participants were linked significantly sooner than control participants [median (interquartile range) days, 26.5 (6.0-141.8) vs. 191.5 (21.5-297.0); P = 0.05].

Conclusion: Study results support the preliminary efficacy of Partner Services PrEP to improve linkage to PrEP care and PrEP initiation among BMSM/TW.
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http://dx.doi.org/10.1097/QAI.0000000000002548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103968PMC
February 2021

The potential of online social networking data for augmenting the study of high-risk personal networks among young men who have sex with men at-risk for HIV.

Soc Networks 2020 Oct 2;63:201-212. Epub 2020 Jul 2.

Chicago Center for HIV Elimination, University of Chicago, Chicago, IL.

Capturing dynamics in high-risk personal networks is essential for preventing HIV transmission. Online social networking data offer incentive to augment traditional selfreported approaches for network enumeration. To explore what online networks reveal about dynamics among high-risk associates, we examine the relationship between egocentric confidant and sex networks and personal Facebook friendship networks of a cohort of young Black men who have sex with men. Although overlap exists between self-reported and Facebook associates, the stabilities of each were unrelated. Confidants who were also Facebook friends with a respondent were, however, more likely to be retained. Thus, Facebook networks contain stable confidants.
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http://dx.doi.org/10.1016/j.socnet.2020.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583251PMC
October 2020

Medical, therapeutic, and recreational use of cannabis among young men who have sex with men living with HIV.

Addict Res Theory 2020 26;28(3):250-259. Epub 2019 Jun 26.

Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.

Cannabis plays a role in symptoms management in HIV, especially the alleviation of pain and nausea and stimulation of appetite, and prevalence of cannabis use in HIV-positive populations exceeds that of the general U.S. population. Previous research has described an "overlap" between medical and recreational cannabis use among persons living with HIV. To understand better the motives associated cannabis use among young men who have sex with men living with HIV (HIV+ YMSM), we conducted semi-structured interviews with 30 HIV+YMSM in Denver and Chicago. Interviews were audio-recorded, transcribed, and coded by a diverse team of analysts. In addition to findings that mapped onto previously identified medical motives and recreational motives, we identified several themes that straddled medical and recreational use in a domain we describe as therapeutic. Themes identified in this therapeutic domain of cannabis use include (a) enhanced introspection among individuals that promotes psychological adjustment to an HIV diagnosis, improved medical management, and future orientation; (b) reflection processes that mitigate interpersonal conflict and improve interpersonal communication; and (c) a social-therapeutic phenomena of cannabis use among young persons with living HIV that is characterized by both enhanced introspection and improved interpersonal communication. Our findings suggest a spectrum of cannabis use among HIV+ YMSM that may be characterized not only by an overlap between medical and recreational use, but also by a distinct therapeutic domain that incorporates stress alleviation and cognitive expansion processes to improve focus on HIV management and self-care.
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http://dx.doi.org/10.1080/16066359.2019.1629427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500448PMC
June 2019

Social network characteristics are correlated with dietary patterns among middle aged and older South Asians living in the United States (U.S.).

BMC Nutr 2020 11;6:40. Epub 2020 Sep 11.

Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 420 E Superior, Rubloff Building 6th Floor, Chicago, IL 60611 USA.

Background: Social and cultural norms, operating through social networks, may influence an individual's dietary choices. We examined correlations between social network characteristics and dietary patterns among South Asians in the United States (U.S.).

Methods: Data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Social Network study were analyzed among 756 participants (mean age = 59 y standard deviation [SD] = 9 y; 44% women). A culturally adapted, validated food frequency questionnaire was used for dietary assessment. A posteriori dietary patterns using principal component analysis were named 1) animal protein, 2) fried snacks, sweets and high-fat dairy, and 3) fruits, vegetables, nuts and legumes. Social network characteristics were assessed using a standard egocentric approach, where participants (egos) self-reported data on perceived dietary habits of their network members. Partial correlations between social network characteristics and egos' dietary patterns were examined.

Results: The mean social network size of egos was 4.2 (SD = 1.1), with high proportion of network members being family (72%), South Asian ethnicity (89%), and half having daily contact. Animal protein pattern scores were negatively correlated with fruits and cooked vegetables consumption of network. Fried snacks, sweets and high-fat dairy pattern scores were positively correlated with sugar-sweetened beverages, South Asian sweets, fried/fast foods and (clarified butter) consumption of network. Fruits, vegetables, nuts and legumes pattern scores were positively correlated with vegetables, fruits, and brown rice/quinoa consumption of network.

Conclusions: Network member characteristics and their perceived dietary behaviors were correlated with dietary patterns of egos. Dietary intervention studies among South Asians should consider social network characteristics as candidate components for dietary intervention.
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http://dx.doi.org/10.1186/s40795-020-00368-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488332PMC
September 2020

Work2Prevent, an Employment Intervention Program as HIV Prevention for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 3): Protocol for a Single-Arm Community-Based Trial to Assess Feasibility and Acceptability in a Real-World Setting.

JMIR Res Protoc 2020 Sep 11;9(9):e18051. Epub 2020 Sep 11.

Department of Medicine, University of Chicago, Chicago, IL, United States.

Background: In the United States, young cisgender men who have sex with men (YMSM), young transgender women (YTW), and gender nonconforming (GNC) youth face elevated rates of HIV infection. However, racial and ethnic disparities in adolescent HIV infection cannot be attributed to individual-level factors alone and are situated within larger social and structural contexts that marginalize and predispose sexual and gender minority youth of color to HIV. Addressing broader ecological factors that drive transmission requires interventions that focus on the distal drivers of HIV infection, including violence exposure, housing, food insecurity, educational attainment, and employment. Given the ways that economic instability may make YMSM, YTW, and GNC youth of color vulnerable to HIV exposure, this study focuses on employment as an HIV prevention intervention. More specifically, the intervention, called Work2Prevent (W2P), targets economic stability through job readiness and employment as a means of preventing behaviors and factors associated with adolescent and young adult HIV, such as transactional sex work and homelessness. The intervention was adapted from iFOUR, an evidence-based employment program for HIV-positive adults in phase 1 of this study, and pilot tested in a university-based setting in phase 2.

Objective: This paper aims to describe the protocol for the community-based test phase of W2P. The purpose of this phase was to pilot test a tailored, theoretically informed employment intervention program among YMSM, YTW, and GNC youth of color within a lesbian, gay, bisexual, transgender, and queer (LGBTQ) community setting.

Methods: The employment intervention was pilot tested using a single-arm pretest-posttest trial design implemented among a sample of vulnerable YMSM, YTW, and GNC youth of color using services within a community-based LGBTQ center. Assessments will examine intervention feasibility, acceptability, and preliminary estimates of efficacy.

Results: Phase 3 of W2P research activities began in May 2019 and was completed in December 2019. Overall, 41 participants were enrolled in the community-based pilot.

Conclusions: This study will assess intervention feasibility and acceptability in the target populations and determine preliminary efficacy of the intervention to increase employment and reduce vulnerability to HIV when implemented in a community-based setting serving LGBTQ youth of color. Testing the intervention in a community setting is an opportunity to evaluate how recruitment, retention, and other outcomes are impacted by delivery in a venue akin to where this intervention could eventually be used by nonresearchers. If W2P demonstrates feasibility and acceptability, a larger multisite trial implemented in multiple community settings serving YMSM, YTW, and GNC youth of color is planned.

Trial Registration: ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310.

International Registered Report Identifier (irrid): DERR1-10.2196/18051.
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http://dx.doi.org/10.2196/18051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519435PMC
September 2020

The multiplex social environments of young Black men who have sex with men: How online and offline social structures impact HIV prevention and sex behavior engagement.

J Soc Struct 2019 Aug;20(3):70-95

Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.

In the United States, young Black men who have sex with men (YBMSM) remain disproportionately affected by HIV. The social networks in which YBMSM are embedded are generally understood to be critical factors in understanding their vulnerability. In this study, we acknowledge the relational richness of YBMSMs' social environments (what we define as multiplexity) and their increasing prioritization of online social networking sites (SNS). Specifically, we investigate whether protective and/or risky features of YBMSMs' Facebook friendships and group affiliations are related to their HIV prevention and sex behavior engagement, while also accounting for features of their offline confidant (or support) and sex networks. Using data from a population-based cohort study of YBMSM living in Chicago (N=268), we perform a series of multiple logistic regression analyses to examine associations between features of YBMSMs' Facebook, confidant, and sexual networks with three prevention outcomes and three sex behavior outcomes, while also controlling for factors at the individual and structural levels. Results show that network features play a more significant role in predicting engagement in sex behaviors than prevention behaviors. Specifically, having more confidants, having confidants who are family members, meeting sex partners online, having more YBMSM Facebook friends, belonging to Facebook groups with an LGBTQ focus, and having greater subject diversity in one's Facebook group affiliations were significantly associated with one or more sex behavior outcomes. We conclude with a discussion of the implications of our findings for HIV prevention intervention efforts.
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http://dx.doi.org/10.21307/joss-2019-007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449318PMC
August 2019

An Employment Intervention Program (Work2Prevent) for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 1): Protocol for Determining Essential Intervention Components Using Qualitative Interviews and Focus Groups.

JMIR Res Protoc 2020 Aug 10;9(8):e16384. Epub 2020 Aug 10.

Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

Background: HIV continues to have a disparate impact on young cisgender men who have sex with men (YMSM), young trans women (YTW), and gender-nonconforming (GNC) youth who are assigned male at birth. Outcomes are generally worse among youth of color. Experiences of discrimination and marginalization often limit educational attainment and may even more directly limit access to gainful employment. Though seemingly distal, these experiences influence young people's proximity to HIV risk by limiting their access to health care and potentially moving them toward sex work as a means of income as well as increased substance use. Work2Prevent (W2P) aims to achieve economic stability through employment as a structural-level intervention for preventing adolescent and young adult HIV infection. The study will pilot-test an effective, theoretically driven employment program (increased individual income and independence [iFOUR]), for HIV-positive adults, and adapt it to the needs of black and Latinx YMSM, YTW, and GNC youth aged 16 to 24 years who are vulnerable to HIV exposure.

Objective: This paper aimed to describe the protocol for the exploratory phase of W2P. The purpose of this phase was to determine the essential components needed for a structural-level employment intervention aimed at increasing job-seeking self-efficacy and career readiness among black and Latinx YMSM, YTW, and GNC youth aged 16 to 24 years.

Methods: The exploratory phase of the W2P study consisted of in-depth interviews and focus groups with members of the target community as well as brief interviews with lesbian, gay, bisexual, transgender, and queer (LGBTQ)-inclusive employers. The study team will conduct in-depth interviews with up to 12 YMSM and 12 YTW and GNC youth, up to 10 focus groups with a maximum of 40 YMSM and 40 YTW and GNC youth, and up to 40 brief interviews with LGBTQ-inclusive employers. Participants will be recruited through a community-based recruiter, passive recruitment in community spaces and on social media, and active recruitment by research staff in community spaces serving LGBTQ youth.

Results: In-depth interviews were conducted with 21 participants, and 7 focus groups were conducted with 46 participants in total. In addition, 19 brief interviews with LGBTQ-inclusive employers were conducted. The analysis of the data is underway.

Conclusions: Preliminary findings from the formative phase of the study will be used to inform the tailoring and refinement of the iFOUR adult-based intervention into the youth-focused W2P intervention curriculum. Perspectives from YMSM, YTW, GNC youth, and LGBTQ-inclusive employers offer a multidimensional view of the barriers and facilitators to adolescent and young adult LGBTQ employment. This information is critical to the development of a culturally appropriate and relevant youth-focused intervention.

Trial Registration: ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310.

International Registered Report Identifier (irrid): DERR1-10.2196/16384.
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http://dx.doi.org/10.2196/16384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445600PMC
August 2020

An Employment Intervention Program (Work2Prevent) for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 2): Protocol for a Single-Arm Mixed Methods Pilot Test to Assess Feasibility and Acceptability.

JMIR Res Protoc 2020 Aug 10;9(8):e16401. Epub 2020 Aug 10.

Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

Background: Young cisgender men who have sex with men (YMSM), young transgender women (YTW), and gender nonconforming (GNC) youth of color face substantial economic and health disparities. In particular, HIV risk and infection among these groups remains a significant public health issue. In 2017, 17% of all new HIV diagnoses were attributed to male-to-male sexual contact among adolescents and young adults aged 13 to 24 years. However, such disparities cannot be attributed to individual-level factors alone but rather are situated within larger social and structural contexts that marginalize and predispose YMSM, YTW, and GNC youth of color to increased HIV exposure. Addressing social and structural risk factors requires intervention on distal drivers of HIV risk, including employment and economic stability. The Work2Prevent (W2P) study aims to target economic stability through job readiness and employment as a structural-level intervention for preventing adolescent and young adult HIV among black and Latinx YMSM, YTW, and GNC youth. This study seeks to assess intervention feasibility and acceptability in the target populations and determine preliminary efficacy of the intervention to increase employment and reduce sexual risk behaviors.

Objective: The goal of the research is to pilot-test a tailored, theoretically informed employment intervention program among YMSM, YTW, and GNC youth of color. This intervention was adapted from Increased Individual Income and Independence, an existing evidence-based employment program for HIV-positive adults during phase 1 of the W2P study.

Methods: The employment intervention will be pilot-tested among vulnerable YMSM, YTW, and GNC youth of color in a single-arm pre-post trial to assess feasibility, acceptability, and preliminary estimates of efficacy.

Results: Research activities began in March 2018 and were completed in November 2019. Overall, 5 participants were enrolled in the pretest and 51 participants were enrolled in the pilot.

Conclusions: Interventions that address the social and structural drivers of HIV exposure and infection are sorely needed in order to successfully bend the curve in the adolescent and young adult HIV epidemic. Employment as prevention has the potential to be a scalable intervention that can be deployed among this group.

Trial Registration: ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310.

International Registered Report Identifier (irrid): DERR1-10.2196/16401.
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http://dx.doi.org/10.2196/16401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445605PMC
August 2020

Social Network Interventions for HIV Transmission Elimination.

Curr HIV/AIDS Rep 2020 10;17(5):450-457

Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.

Purpose Of Review: Network interventions for HIV prevention represent a potential area for growth in a globalizing world, where persons are more easily connected to one another through social media and networking applications. The basic tenets of network interventions such as (1) selection of a change agent, (2) segmentation, (3) induction, and (4) alteration represent myriad ways to structure network interventions for HIV prevention with the potential for large public health impact.

Recent Findings: Recent studies have employed the use of social networking websites such as Facebook to identify key persons to recruit others and disseminate information aimed at decreasing HIV transmission and improving safe sex practices among groups who are more vulnerable to HIV acquisition. Many of these interventions have successfully decreased HIV risk behaviors as well as decreased the spread of HIV among intervention cohorts. Network interventions for HIV prevention provide more opportunities to reach populations who have not been reached through typical efforts employed in clinical and public health settings, though they are not currently widely employed by the public health community and other stakeholders.
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http://dx.doi.org/10.1007/s11904-020-00524-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497372PMC
October 2020

Individual and Social Network Structure Characteristics Associated with Peer Change Agent Engagement and Impact in a PrEP Intervention.

AIDS Behav 2020 Dec;24(12):3385-3394

Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA, USA.

Interventions that utilize the influence of peer change agents (PCAs) have been shown to be effective strategies for engaging key populations in HIV prevention. To date, little is known about the characteristics of PCAs associated with their effectiveness. Drawing on data from a peer leader PrEP intervention for young Black men who have sex with men (YBMSM) (N = 423), we evaluated the effects of experiential (i.e., living with HIV, PrEP awareness, PrEP use), psychographic (i.e., self-perceived leadership, innovativeness), and network (i.e., degree centrality, eigenvector centrality, and brokerage) characteristics on three effectiveness outcomes: (1) recruiting peers into the study; (2) completing "booster" sessions; and (3) linking peers to PrEP care. For each outcome, multivariable regressions were performed. On average, PCAs recruited 0.89 peers, completed 1.99 boosters, and had 1.33 network peers linked to PrEP care. Experiential factors: Prior PrEP awareness was positively associated with booster completion. Network factors: Being a network broker (i.e., connecting otherwise disconnected communities) was positively associated with peer recruitment but negatively associated with linking peers to PrEP, and degree centrality (i.e., the number of network connections someone has) and eigenvector centrality (i.e., being connected to well-connected network associates) were positively associated with linking peers to PrEP. Psychographic characteristics were not associated with any outcome. These findings can be used to inform PCA selection and to identify subpopulations who require additional support to excel as PCAs.
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http://dx.doi.org/10.1007/s10461-020-02911-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7655600PMC
December 2020

Longitudinal cohort of HIV-negative transgender women of colour in New York City: protocol for the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study.

BMJ Open 2020 04 1;10(4):e032876. Epub 2020 Apr 1.

Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA

Introduction: In the USA, transgender women are among the most vulnerable to HIV. In particular, transgender women of colour face high rates of infection and low uptake of important HIV prevention tools, including pre-exposure prophylaxis (PrEP). This paper describes the design, sampling methods, data collection and analyses of the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study. In collaboration with communities of transgender women of colour, TURNNT aims to explore the complex social and environmental (ie, neighbourhood) structures that affect HIV prevention and other aspects of health in order to identify avenues for intervention.

Methods And Analyses: TURNNT is a prospective cohort study, which will recruit 300 transgender women of colour (150 Black/African American, 100 Latina and 50 Asian/Pacific Islander participants) in New York City. There will be three waves of data collection separated by 6 months. At each wave, participants will provide information on their relationships, social and sexual networks, and neighbourhoods. Global position system technology will be used to generate individual daily path areas in order to estimate neighbourhood-level exposures. Multivariate analyses will be conducted to assess cross-sectional and longitudinal, independent and synergistic associations of personal relationships (notably individual social capital), social and sexual networks, and neighbourhood factors (notably neighbourhood-level social cohesion) with PrEP uptake and discontinuation.

Ethics And Dissemination: The TURNNT protocol was approved by the Columbia University Institutional Review Board (reference no. AAAS8164). This study will provide novel insights into the relationship, network and neighbourhood factors that influence HIV prevention behaviours among transgender women of colour and facilitate exploration of this population's health and well-being more broadly. Through community-based dissemination events and consultation with policy makers, this foundational work will be used to guide the development and implementation of future interventions with and for transgender women of colour.
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http://dx.doi.org/10.1136/bmjopen-2019-032876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170618PMC
April 2020

: success and stigma following release of the first sex-positive PrEP public health campaign.

Cult Health Sex 2021 Mar 26;23(3):397-413. Epub 2020 Mar 26.

Department of Medicine, University of Chicago, Chicago, IL, USA.

Pre-exposure prophylaxis (PrEP) is an effective yet under-utilised method for preventing HIV transmission in high-risk groups. Despite ongoing social marketing to increase PrEP awareness, few studies have evaluated public responses. This paper contextualises negative responses to Chicago's PrEP4Love campaign. In February 2016, a sex-positive ad campaign called PrEP4Love was launched online and throughout public spaces in Chicago. A gender and sexuality inclusive campaign, PrEP4Love is intended to be culturally responsive and sex positive, while retaining a focus on risk reduction. Advertisements prominently feature Black sexual minority men, and Black transgender women, and were strategically placed in diverse Chicago neighbourhoods. In response, there were 212 new callers to the PrEPLine during the two-month study period. Negative responses were concerned with: negatively depicting Black homosexuality (4), general anti-LGBTQ comments (7), adverse effects on children (6), sexually explicit nature (5), and general stigmatisation of racial minorities (4). Discussion focuses on sex-positive frameworks, normalising intimacy, stigma and historical mistrust of medical and pharmaceutical institutions, and the social meanings of biomedical prevention technologies (e.g. PrEP) in relation to dominant norms of sexuality and gender. This study is the first to investigate public responses to a sex-positive PrEP campaign. More studies of PrEP social marketing are needed to evaluate targeted public health campaigns to guide future PrEP promotion strategies.
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http://dx.doi.org/10.1080/13691058.2020.1715482DOI Listing
March 2021

Out-of-pocket costs and HIV pre-exposure prophylaxis persistence in a US multicity demonstration project.

Health Serv Res 2020 08 20;55(4):524-530. Epub 2020 Mar 20.

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.

Objective: To evaluate whether out-of-pocket (OOP) costs reduced HIV pre-exposure prophylaxis (PrEP) persistence.

Data Source: Participants from five urban community health centers (CHCs) in four US cities enrolled in a PrEP demonstration project from September 2014 to August 2017.

Study Design: Patients initiating PrEP were followed quarterly until they withdrew from PrEP care or the study ended. Self-reported OOP medication and clinic visit costs were assessed by semiannual questionnaires. Persistence was defined as the time from study enrollment to the last visit after which two subsequent 3-month visits were missed. Multivariable Cox proportional hazard regression was used to assess the effect of demographics, insurance, and OOP costs on PrEP persistence.

Principal Findings: Among 918 participants with OOP cost data, the average quarterly OOP cost was $34 (median: $5, IQR: $0-$25). Participants who were men, White, employed, completed college, and had commercial insurance had higher OOP costs. Higher OOP costs were not associated with lower PrEP persistence by Cox proportional hazards regression (adjusted hazard ratio = 1.00 per $50 increase, 95% CI = 0.97, 1.02).

Conclusion: Among patients receiving care from these urban CHCs, OOP costs were low and did not undermine PrEP persistence.
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http://dx.doi.org/10.1111/1475-6773.13285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375996PMC
August 2020

Socio-Structural and Neighborhood Predictors of Incident Criminal Justice Involvement in a Population-Based Cohort of Young Black MSM and Transgender Women.

J Urban Health 2020 10;97(5):623-634

Departments of Medicine and Public Health Sciences, Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.

Black men who have sex with men (MSM) and transgender women are disproportionately affected by criminal justice involvement (CJI) and HIV. This study recruited 618 young Black MSM and transgender women in Chicago, IL, using respondent-driven sampling between 2013 and 2014. Random effects logistic regression evaluated predictors of incident CJI over 18 months of follow-up. Controlling for respondent age, gender and sexual identity, spirituality (aOR 0.56, 95% CI 0.33-0.96), and presence of a mother figure (aOR 0.41, 95% CI 0.19-0.89) were protective against CJI. Economic hardship (financial or residential instability vs. neither aOR 2.23, 95% CI 1.10-4.51), two or more past episodes of CJI vs. none (aOR 2.66, 95% CI 1.40-5.66), and substance use (marijuana use vs. none aOR 2.79, 95% CI 1.23-6.34; other drug use vs. none aOR 4.49, 95% CI 1.66-12.16) were associated with CJI during follow-up. Research to identify and leverage resilience factors that can buffer the effects of socioeconomic marginalization may increase the effectiveness of interventions to address the socio-structural factors that increase the risk for CJI among Black MSM and transgender women. Given the intersection of incarceration, HIV and other STIs, and socio-structural stressors, criminal justice settings are important venues for interventions to reduce health inequities in these populations.
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http://dx.doi.org/10.1007/s11524-020-00428-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7560631PMC
October 2020

Collective Avoidance of Social and Health Venues and HIV Racial Inequities: Network Modeling of Venue Avoidance on Venue Affiliation, Social Networks, and HIV Risk.

Health Educ Behav 2020 04 24;47(2):202-212. Epub 2020 Feb 24.

University of Chicago, Chicago, IL, USA.

Many younger Black men who have sex with men (YBMSM) are exposed to homonegativity, societal stigma, and racial discrimination in their social environment. This study uses a social network modeling methodology to identify aspects of the social environment that are not often described, that is, the places and spaces or "venues" where YBMSM socialize or where they receive HIV prevention services. In particular, we identify the structural features of avoidance of these venues as an indicator of negative experiences, using bipartite exponential random graph models. Our study theorizes that YBMSM avoid certain venues en masse through information diffusion among social network members. We specify two social mechanisms of collective venue avoidance-(1) homophily (i.e., ego-alter similarity in venue avoidance) and (2) popular opinion leaders (as early adopters)-and test the corresponding hypotheses that (Hypothesis 1) socially connected individuals avoid venues together and that (Hypothesis 2) popular individuals would be more likely to avoid venues. Based on data collected from YBMSM aged 16 to 29 years between 2014 and 2016 in Houston, Texas ( = 227) and Chicago, Illinois ( = 241), results indicate that Hypothesis 1 was supported in both cities but that Hypothesis 2 was supported only in Chicago. The findings suggest that the structural patterns of venue avoidance are different between cities and may inform dissemination of prevention messages and delivery of venue- and social influence-based HIV interventions.
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http://dx.doi.org/10.1177/1090198119876240DOI Listing
April 2020

Facebook group affiliation ties, group topics, and HIV behavioral characteristics among young Black men who have sex with men: Potential for public health intervention.

SSM Popul Health 2019 Dec 2;9:100510. Epub 2019 Nov 2.

Department of Medicine, University of Chicago, Chicago, IL, USA.

•YBMSM were more likely to belong to personal/professional development groups.•YBMSM clustered around pairs of LGBTQ identity, sex, and nightlife groups.•Regular testers tended to belong to LGBTQ identity and nightlife groups.•Those who engaged in condomless sex tended to affiliate with LGBTQ identity groups.•Those who were aware of PrEP aware tended to affiliate with chat groups.
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http://dx.doi.org/10.1016/j.ssmph.2019.100510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978475PMC
December 2019