Publications by authors named "Sonya Arreola"

26 Publications

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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

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

Child Sexual Abuse and Adult Mental Health, Sexual Risk Behaviors, and Drinking Patterns Among Latino Men Who Have Sex With Men.

J Child Sex Abus 2018 Apr 18;27(3):237-253. Epub 2017 Jul 18.

i Columbia University Medical Center , New York, New York, USA.

One in five Latino men who have sex with men has experienced child sexual abuse. Although concerning in itself, child sexual abuse may increase an individuals' likelihood of depression and risk-taking in adult life, including engagement in HIV risk behaviors and alcohol and substance use. It is therefore urgent that researchers and practitioners better understand the long-term effects of child sexual abuse. We utilized logistic and linear regression to assess associations between child sexual abuse (operationalized as forced or coerced sexual activity before age 17) and depression, sexual behaviors, and drinking patterns in a sample of 176 adult Latino men who have sex with men from New York City. Over one-fifth (22%) of participants reported child sexual abuse. In multivariable models, participants with histories of child sexual abuse were significantly more likely than participants without such histories to screen for clinically significant depressive symptoms and heavy drinking and reported more anal sex acts, male sexual partners, and incidents of condomless anal intercourse in the previous three months. These findings confirm a high prevalence of child sexual abuse among Latino men who have sex with men and associations between child sexual abuse and adulthood depressive symptoms, high-risk alcohol consumption, and sexual risk behaviors. We recommend that providers who serve Latino men who have sex with men incorporate child sexual abuse screenings into mental health, HIV prevention, and substance use treatment programs, utilizing approaches that are inclusive of resilience.
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http://dx.doi.org/10.1080/10538712.2017.1343885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5773409PMC
April 2018

Depression and Risk for Problem Drinking in Latino Migrant Day Laborers.

Subst Use Misuse 2017 08 27;52(10):1320-1327. Epub 2017 Mar 27.

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

Background: Given the structural vulnerability of Latino migrant day laborers (LMDLs) to unstable and poorly paying work, harsh living conditions and frequent inability to support or even visit families in country of origin, psychological distress is a common response and one frequently implicated in risky outcomes such as problem drinking.

Objectives: The purpose of this study was to examine the relation of three different forms of psychological distress to problem drinking in LMDLs: depression, anxiety, and desesperación, the latter a popular Latino culture-based idiom of psychological distress.

Methods: A cross sectional survey of 344 LMDLs was conducted in the San Francisco Bay Area from January to June of 2014. Independent contributions of depression, anxiety, and desesperación in explaining problem drinking as measured by a modified version of the AUDIT, were assessed using multiple linear regression analysis.

Results: Depression was significantly associated with risk for problem drinking while other forms of psychological distress were not. Conclusion/Importance: Findings provide stronger empirical support for the association between depression and problem drinking, a long suspected but under-demonstrated relationship in the literature on LMDLs. Implications for preventing problem drinking as well as mitigating psychological distress more generally for LMDLs are discussed.
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http://dx.doi.org/10.1080/10826084.2016.1276599DOI Listing
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

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

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

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

SSM Popul Health 2016 Dec 15;2:32-42. Epub 2016 Feb 15.

University of California, San Francisco, USA.

The purpose of this study was to better understand the relation between psychological distress and alcohol and substance related sexual risk in Latino migrant day laborers (LMDLs). In addition to examining the roles of depression and anxiety, it was also necessary to examine the role of , a popular Latino idiom of distress frequently expressed by LMDLs in response to the thwarting of major migration related life goals such as traveling to the U.S. in search of work to support families, projects and purchases in country of origin. Given the structural vulnerability of LMDLs to under-employment and frequent unemployment, LMDLs also refer to as a prelude to problem drinking, substance use, and sexual risk taking. Hence we developed and validated a scale of for LMDLs to explore this culturally relevant construct of psychological distress in this unique population of Latinos. Based on a cross sectional survey of 344 LMDLs, this study found that the subscale of predicted alcohol-related sexual risk taking, while depression predicted substance-related sexual risk taking. These findings are discussed including implications of preventing alcohol and substance related sexual risk taking in LMDLs.
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http://dx.doi.org/10.1016/j.ssmph.2016.01.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5757762PMC
December 2016

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

Structural vulnerability and problem drinking among Latino migrant day laborers in the San Francisco Bay Area.

J Health Care Poor Underserved 2014 Aug;25(3):1291-307

Latino migrant day laborers (LMDLs) live under challenging conditions in the San Francisco Bay Area. This study explored day laborer alcohol use guided by a structural vulnerability framework, specifically problem vs. non-problem drinking as perceived by LMDLs and how they cope with or try to avoid problem drinking given their broader environment. The study utilized ethnographic methods including in-depth semi-structured qualitative interviews with 51 LMDLs. Findings revealed the considerable challenge of avoiding problem drinking given socio-environmental factors that influence drinking: impoverished living and working conditions, prolonged separation from home and family, lack of work authorization, consequent distress and negative mood states, and peer pressure to drink. While participants shared strategies to avoid problem drinking, the success of individual-level efforts is limited given the harsh structural environmental factors that define day laborers' daily lives. Discussed are implications for prevention and intervention strategies at the individual, community, national and international levels.
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http://dx.doi.org/10.1353/hpu.2014.0121DOI Listing
August 2014

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

"As Good As It Gets": Undocumented Latino Day Laborers Negotiating Discrimination in San Francisco and Berkeley, California, USA.

City Soc (Wash) 2014 Apr;26(1):29-50

San Francisco State University.

Undocumented Latino day laborers in the United States are vulnerable to being arrested and expelled at any time. This social fact shapes their everyday lives in terms of actions taken and strategies deployed to mitigate being confronted, profiled, and possibly incarcerated and deported. While perceptions of threat and bouts of discrimination are routine among undocumented Latino day laborers, their specific nature vary according to multiple social factors and structural forces that differ significantly from locale to locale. The experience of discrimination is often tacitly negotiated through perceptions, decisions, and actions toward avoiding or moderating its ill effects. This essay examines urban undocumented Latino day laborers over a variety of sites in the greater San Francisco Bay Area, which, compared to many metropolitan areas in the U.S. is "as good as it gets" in terms of being socially tolerated and relatively safe from persecution. Nonetheless, tacit negotiations are necessary to withstand or overcome challenges presented by idiosyncratic and ever changing global, national/state, and local dynamics of discrimination. [undocumented Latino laborers, social exclusion, discrimination, tacit negotiation].
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http://dx.doi.org/10.1111/ciso.12033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4043379PMC
April 2014

Characteristics of people who initiate injection drug use later in life.

Drug Alcohol Depend 2014 May 26;138:244-50. Epub 2014 Feb 26.

Urban Health Program, RTI International, 351 California St., San Francisco, CA 94104, United States.

Background: Studies report that among people who inject drugs (PWID), approximately 1 in 7 initiated injection during their thirties or later (referred to hereafter as "late initiates"). However, little is known about individuals who are late initiates. This study aims to describe characteristics of late initiates to drug injection and to examine how they differ from people who initiated drug injection prior to the age of 30 ("typical initiates").

Methods: We recruited 696 active PWID in Los Angeles and San Francisco, California between 2011 and 2013, using targeted sampling and street outreach methods. Participants completed personal interviews that covered items on demographics, drug use history and practices, injection initiation episode, HIV injection- and sex-related risk, health care utilization among others. We used bivariate and multivariate analyses to examine factors associated being a late initiate.

Results: In our sample, 19% of participants who were 30 years or older were classified as late initiates. In multivariate analysis controlling for city, late initiates had higher odds of being female and African American, having been in treatment prior to initiation, initiating illicit drug use at an older age, and being assisted into injection by someone of the same age or younger. Late initiates had lower odds of frequent recent injection, and having a bipolar disorder diagnosis.

Conclusion: Late initiates comprise a significant proportion of active PWIDs. More study on the health consequences of late initiation are needed as are interventions to prevent transition to drug injection among at-risk populations.
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http://dx.doi.org/10.1016/j.drugalcdep.2014.02.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035351PMC
May 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

African-American and Hispanic perceptions of HIV vaccine clinical research: a qualitative study.

Am J Health Promot 2014 Nov-Dec;29(2):e82-90. Epub 2014 Jan 16.

Purpose: To examine perceptions of phase-I human immunodeficiency virus (HIV) vaccine trial participation among African-Americans and Hispanics in San Francisco, California.

Design: Qualitative, semistructured interviews.

Setting: San Francisco Department of Health.

Participants: Thirty-six African-American and Hispanic men and women, 18 to 50 years of age, residing in the San Francisco Bay Area.

Method: Purposive sampling using advertisements, community-based organization rosters, and snowball referrals. Thematic analysis of transcripts identified salient themes and patterns.

Results: Participants viewed participation in HIV research as important; however, they held that HIV was not a health priority given limited awareness about HIV research or beliefs that only infected or high-risk persons were eligible for participation. Altruism and personal gain, trustworthy trial staff, convenient schedules and facilities, and involvement of trusted community groups in recruitment were perceived to motivate participants. Concerns about the social consequences of participating in HIV research and product-related side effects were seen as discouraging participation. Limitations include the possibility that participants in interview research have more favorable views of biomedical research than those who refuse to participate.

Conclusion: Historically, African-Americans and Hispanics in the United States have had limited participation in HIV trials. Understanding their perceptions of HIV biomedical research, identifying facilitators and barriers to participation, addressing misinformation about HIV, distorted risk perceptions, HIV stigma, and providing accessible opportunities to participate are imperative to ensure health equity and generalizability of findings.
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http://dx.doi.org/10.4278/ajhp.130125-QUAL-48DOI Listing
September 2016

African-American and Hispanic perceptions of HIV vaccine clinical research: a qualitative study.

Am J Health Promot 2014 Nov-Dec;29(2):e82-90. Epub 2014 Jan 16.

Purpose: To examine perceptions of phase-I human immunodeficiency virus (HIV) vaccine trial participation among African-Americans and Hispanics in San Francisco, California.

Design: Qualitative, semistructured interviews.

Setting: San Francisco Department of Health.

Participants: Thirty-six African-American and Hispanic men and women, 18 to 50 years of age, residing in the San Francisco Bay Area.

Method: Purposive sampling using advertisements, community-based organization rosters, and snowball referrals. Thematic analysis of transcripts identified salient themes and patterns.

Results: Participants viewed participation in HIV research as important; however, they held that HIV was not a health priority given limited awareness about HIV research or beliefs that only infected or high-risk persons were eligible for participation. Altruism and personal gain, trustworthy trial staff, convenient schedules and facilities, and involvement of trusted community groups in recruitment were perceived to motivate participants. Concerns about the social consequences of participating in HIV research and product-related side effects were seen as discouraging participation. Limitations include the possibility that participants in interview research have more favorable views of biomedical research than those who refuse to participate.

Conclusion: Historically, African-Americans and Hispanics in the United States have had limited participation in HIV trials. Understanding their perceptions of HIV biomedical research, identifying facilitators and barriers to participation, addressing misinformation about HIV, distorted risk perceptions, HIV stigma, and providing accessible opportunities to participate are imperative to ensure health equity and generalizability of findings.
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http://dx.doi.org/10.4278/ajhp.130125-QUAL-48DOI Listing
September 2016

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

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

Sexual health of Latino migrant day labourers under conditions of structural vulnerability.

Cult Health Sex 2013 9;15(1):58-72. Epub 2012 Nov 9.

School of Social Welfare, University of California, Berkeley, USA.

The purpose of this paper is to explore the context of the sexual health of Latino migrant day labourers in the USA, challenges to sexual health and ways of coping, with attention to conditions of structural vulnerability permeating the lives of this unique Latino population. Given the limited information about this topic and population, ethnographic research employing in-depth semi-structured interviews with 51 labourers, recruited through purposive sampling in the San Francisco Bay Area, was utilised. The sexual health aspirations of the men are deeply embedded in the core value and practice of Latino familismo or, in this case, the central goal of securing a family headed by men as providers and present husbands/fathers. However, such goals are frequently thwarted by the poverty engendering work and prolonged separations from home that characterise predominantly undocumented day labour in the USA. Resulting goal frustration, combined with pent up sexual urges, often lead to sexual risk in spite of efforts to cope with challenges to sexual health. Unless community-, state- and national-level interventions are developed to mitigate the pronounced structural vulnerability of migrant day labourers, individual level interventions to promote sexual health, and decrease risk and distress, are likely to have diminishing returns.
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http://dx.doi.org/10.1080/13691058.2012.740075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743724PMC
May 2013

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

Int J Drug Policy 2012 Sep 3;23(5):385-92. Epub 2012 Sep 3.

Urban Health Program, RTI International, USA.

Background: The intersection of drug use, sexual pleasure and sexual risk behaviour is rarely explored when it comes to poor women who use drugs. This paper explores the relationship between sexual behaviour and methamphetamine use in a community-based sample of women, exploring not only risk, but also desire, pleasure and the challenges of overcoming trauma.

Methods: Quantitative data were collected using standard epidemiological methods (N=322) for community-based studies. In addition, using purposive sampling, qualitative data were collected among a subset of participants (n=34). Data were integrated for mixed methods analysis.

Results: While many participants reported sexual risk behaviour (unprotected vaginal or anal intercourse) in the quantitative survey, sexual risk was not the central narrative pertaining to sexual behaviour and methamphetamine use in qualitative findings. Rather, desire, pleasure and disinhibition arose as central themes. Women described feelings of power and agency related to sexual behaviour while high on methamphetamine. Findings were mixed on whether methamphetamine use increased sexual risk behaviour.

Conclusion: The use of mixed methods afforded important insights into the sexual behaviour and priorities of methamphetamine-using women. Efforts to reduce sexual risk should recognize and valorize the positive aspects of methamphetamine use for some women, building on positive feelings of power and agency as an approach to harm minimization.
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http://dx.doi.org/10.1016/j.drugpo.2012.07.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3466046PMC
September 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

The prospect of implementing a Safer Injection Facility in San Francisco: perspectives of community stakeholders.

Int J Drug Policy 2011 May 18;22(3):239-41. Epub 2011 Feb 18.

Urban Health Program, RTI International, San Francisco Regional Office, CA 94104, United States.

Background: Government-sanctioned Safer Injection Facilities (SIFs) have been implemented around the world to address public health and public order concerns associated with injection drug use. The goal of this study was to investigate how community stakeholders in San Francisco's Tenderloin district respond to the idea of implementing a SIF.

Methods: Qualitative in-depth interviews were conducted with 20 purposively sampled stakeholders including representatives from neighbourhood and business associations, politicians, law enforcement, religious leaders, school officials, community activists and service providers. Data were analysed using an inductive approach.

Results: Stakeholders were concerned that implementation of a SIF would further degrade a community struggling with safety and cleanliness and questioned the efficacy of harm reduction strategies to address drug use. Stakeholders were open to dialogue about how a SIF might support neighbourhood goals, stressed the importance of respect and collaboration between stakeholders and those potentially implementing a SIF, and were interested in evidence of the impact SIFs have on communities. Government protection and political leadership would be necessary to implement a SIF.

Conclusions: Employment of a community collaborative model combined with political leadership could move the policy debate about implementation of a SIF in San Francisco forward.
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http://dx.doi.org/10.1016/j.drugpo.2011.01.001DOI Listing
May 2011

Childhood sexual abuse and the sociocultural context of sexual risk among adult Latino gay and bisexual men.

Am J Public Health 2009 Oct 16;99 Suppl 2:S432-8. Epub 2009 Apr 16.

HIV Research Section, AIDS Office, San Francisco Department of Public Health, 25 Van Ness Ave, Suite 710, San Francisco, CA 94102, USA.

Objectives: We sought to examine the relationships among childhood sexual abuse, social discrimination, psychological distress, and HIV-risk among Latino gay and bisexual men in the United States.

Methods: Data were from a probability sample of 912 men from Miami, FL; Los Angeles, CA; and New York, NY. We used logistic regression and path analyses to examine direct and indirect effects of childhood sexual abuse on psychological distress and sexual risk behavior.

Results: We found a 15.8% (95% confidence interval = 12.3%, 19.2%) prevalence of childhood sexual abuse. Not having sex before age 16 years and having consensual sex before age 16 years did not differ from each other in predicting any of the outcomes of interest. Forced sex was associated with a significantly increased risk for all outcomes. A path analyses yielded direct effects of childhood sexual abuse and exposure to homophobia during childhood and during adulthood on psychological distress and indirect effects on risky sexual behavior.

Conclusions: HIV-risk patterns among Latino gay and bisexual men are related to childhood sexual abuse and a social context of discrimination, which combined lead to symptoms of psychological distress and participation in risky sexual situations that increase risky sexual behaviors associated with HIV acquisition.
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http://dx.doi.org/10.2105/AJPH.2008.138925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2865208PMC
October 2009

Childhood sexual experiences and adult health sequelae among gay and bisexual men: defining childhood sexual abuse.

J Sex Res 2008 Jul-Sep;45(3):246-52

HIV Research Section, San Francisco Department of Public Health, San Francisco, CA 94102, USA.

Gay and bisexual men carry the burden of HIV infections in the United States and have high rates of childhood sexual abuse that predict HIV and other health outcomes. This study examined differential effects of forced, consensual, and no childhood sexual experiences (CSE) on health outcomes among a probability sample of adult men who have sex with men (MSM). The forced sex group had the highest levels of psychological distress, substance use, and HIV risk. There were no differences in rates of depression and suicidal ideation between the consensual- and no-sex groups. The consensual- and forced-sex groups had higher rates of substance use and transmission risk than the no-sex group. The forced-sex group, however, had significantly higher rates of frequent drug use and high-risk sex than the consensual group. Findings suggest that forced CSEs result in a higher-risk profile than consensual or no childhood sexual experiences, the kind of risk pattern differs between forced and consensual childhood sexual experiences, and the underlying mechanisms that maintain risk patterns may vary. It is important to clarify risk patterns and mechanisms that maintain them differentially for forced and consensual sex groups so that interventions may be tailored to the specific trajectories related to each experience.
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http://dx.doi.org/10.1080/00224490802204431DOI Listing
November 2008

Higher prevalence of childhood sexual abuse among Latino men who have sex with men than non-Latino men who have sex with men: data from the Urban Men's Health Study.

Child Abuse Negl 2005 Mar;29(3):285-90

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

Objective: The prevalence of childhood sexual abuse among Latino adult men who have sex with men who live in the US was estimated because a history of childhood sexual abuse increases HIV sexual risk behaviors and other negative health outcomes in adulthood.

Method: The Urban Men's Health Study is a random-digit telephone probability survey of 2881 adult men who have sex with men (MSM) aged 18 years or older residing in San Francisco, New York, Los Angeles, and Chicago. Self-reported history of childhood sexual abuse was the main outcome measure gathered from 2692 MSM.

Results: A significantly higher proportion of Latino MSM reported sexual abuse before age 13 (22%) than did non-Latino MSM (11%).

Conclusions: Latino MSM are twice as likely to report a history of childhood sexual abuse than are non-Latino MSM. Given the association between childhood sexual abuse and increased risk for HIV and other negative health outcomes, health providers must remain vigilant to the possibility of childhood sexual abuse histories among their Latino patients.
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http://dx.doi.org/10.1016/j.chiabu.2004.09.003DOI Listing
March 2005