A Longitudinal Investigation of Syndemic Conditions Among Young Gay, Bisexual, and Other MSM: The P18 Cohort Study

Halkitis, Perry N.; Kapadia, Farzana; Bub, Kristen L.; Barton, Staci C.; Moreira, Alvaro D.; Stults, Christopher B.

doi:10.1007/s10461-014-0892-y

Cited by 73 publications

(62 citation statements)

References 42 publications

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“…In addition, alcohol use, cigarette smoking, stimulants/recreational drug use, and depressive symptoms over time served to increase marijuana use within nearly all marijuana trajectory groups. This finding is consistent with previous studies that found substantial overlap between several types of drug use and other psychosocial health problems [54–56]. Accordingly, any prevention approaches to mitigate these behaviors should not focus on one of these behaviors or conditions but must consider these co-occurring conditions holistically.…”

Section: Discussionsupporting

confidence: 90%

Trajectories of Marijuana Use among HIV-seropositive and HIV-seronegative MSM in the Multicenter AIDS Cohort Study (MACS), 1984–2013

et al. 2016

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To construct longitudinal trajectories of marijuana use in a sample of men who have sex with men living with or at-risk for HIV infection. We determined factors associated with distinct trajectories of use as well as those that serve to modify the course of the trajectory. Data were from 3658 [1439 HIV-seropositive (HIV+) and 2219 HIV-seronegative (HIV−)] participants of the Multicenter AIDS Cohort Study. Frequency of marijuana use was obtained semiannually over a 29-year period (1984–2013). Group-based trajectory models were used to identify the trajectories and to determine predictors and modifiers of the trajectories over time. Four distinct trajectories of marijuana use were identified: abstainer/infrequent (65 %), decreaser (13 %), increaser (12 %) and chronic high (10 %) use groups. HIV+ status was significantly associated with increased odds of membership in the decreaser, increaser and chronic high use groups. Alcohol, smoking, stimulant and other recreational drug use were associated with increasing marijuana use across all four trajectory groups. Antiretroviral therapy use over time was associated with decreasing marijuana use in the abstainer/infrequent and increaser trajectory groups. Having a detectable HIV viral load was associated with increasing marijuana use in the increaser group only. Future investigations are needed to determine whether long-term patterns of use are associated with adverse consequences especially among HIV+ persons.

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Section: Discussionsupporting

confidence: 90%

Trajectories of Marijuana Use among HIV-seropositive and HIV-seronegative MSM in the Multicenter AIDS Cohort Study (MACS), 1984–2013

et al. 2016

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“…This finding indicates that heterosexual men have a greater item mean, or expected item value when the factor item value is equal to zero, for substance use disorder, anxiety, and depression compared to MSM. Our study extends upon findings that syndemics undermine health and persist across the lifetime of heterosexual men, as well as MSM (73). It is furthermore critical to approach men’s (both heterosexual men and MSM) health holistically by addressing the socio-structural inequities they face that may drive their health behavior and exacerbate their syndemic risk (74).…”

Section: Discussionsupporting

confidence: 80%

Substance Use Disorders, Violence, Mental Health, and HIV: Differentiating a Syndemic Factor by Gender and Sexuality

et al. 2017

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This paper measures syndemic substance use disorder, violence, and mental health and compares the syndemic among HIV-infected heterosexual men, heterosexual women, and men who have sex with men (MSM). Data were from a sample of vulnerable, substance-using, HIV-infected people in South Florida between 2010 and 2012 (n=481). We used confirmatory factor analysis to measure a syndemic latent variable and applied a measurement invariance model to identify group differences in the data structure of syndemic co-morbidities among heterosexual men, heterosexual women, and MSM. We found that variables used to measure the syndemic fit each sub-group, supporting that substance use disorder, violence, and mental health coincide in HIV-infected individuals. Heterosexual men and MSM demonstrated similar syndemic latent variable factor loadings, but significantly different item intercepts, indicating that heterosexual men had larger mean values on substance use disorder, anxiety, and depression than MSM. Heterosexual men and heterosexual women demonstrated significantly different syndemic variable factor loadings, indicating that anxiety and depression contribute more (and substance use contributes less) to the syndemic in heterosexual men compared to heterosexual women. MSM and heterosexual women demonstrated similar syndemic latent variable factor loadings and intercepts, but had significantly different factor residual variances indicating more variance in violent victimization and depression for MSM and more variance in stress for heterosexual women than what is captured by the observed syndemic indicators. Furthermore, heterosexual women had a larger syndemic factor mean than MSM, indicating that the syndemic burden is greater among heterosexual women than MSM. Our findings support that measurement invariance can elucidate syndemic differences to tailor interventions to sub-group needs.

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“…However, results from the mediation analysis are similar to findings from a few longitudinal cohort studies. 34,35 Third, participants’ responses were subject to recall and social desirability biases, although the mode of survey administration might have mitigated these biases.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Homophobia and HIV Stigma on HIV Testing Uptake Among Chinese Men Who Have Sex With Men

Wei

Cheung

Yan

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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BACKGROUND Gay and HIV-related stigma and discrimination are major barriers to accessing HIV prevention services among MSM worldwide. We aimed to identify modifiable factors that mediate the relationships between gay and HIV-related stigma and discrimination and HIV testing uptake among Chinese MSM. METHODS We conducted a cross-sectional survey study of 523 HIV-uninfected or unknown MSM in Jiangsu Province, China between November 2013 and January 2014. Multivariable analyses were conducted to examine the associations among experienced homophobia, HIV stigma, and recent HIV testing. Causal mediation parametric analyses were conducted to assess whether depression and social norms mediated hypothesized associations. RESULTS Stronger subjective norms toward testing was associated with higher odds of recent HIV testing (AOR: 1.10, 95% CI: 1.01, 1.21) while increasing levels of depression and HIV stigma were both associated with lower odds of recent testing (AOR: 0.96, 95% CI: 0.92, 0.99; and AOR: 0.91, 95% CI: 0.84, 0.99, respectively). There was an indirect relationship (natural indirect effect) of experienced homophobia on recent testing (ORNIE: 0.96, 95% CI: 0.93, 0.98) mediated (35.0%) through depression. Furthermore, there was an indirect relationship of HIV stigma on recent testing (ORNIE: 0.98, 95% CI: 0.95, 0.99) mediated (19.2%) through subjective norms. CONCLUSIONS Depression and social norms are important mediators of HIV testing uptake among stigmatized Chinese MSM. Therefore, in addition to advocacy efforts and policies that address social-level stigma and discrimination, HIV prevention programs should also address mental health issues and incorporate community-based approaches to changing social norms toward HIV testing.

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A Longitudinal Investigation of Syndemic Conditions Among Young Gay, Bisexual, and Other MSM: The P18 Cohort Study

Cited by 73 publications

References 42 publications

Trajectories of Marijuana Use among HIV-seropositive and HIV-seronegative MSM in the Multicenter AIDS Cohort Study (MACS), 1984–2013

Trajectories of Marijuana Use among HIV-seropositive and HIV-seronegative MSM in the Multicenter AIDS Cohort Study (MACS), 1984–2013

Substance Use Disorders, Violence, Mental Health, and HIV: Differentiating a Syndemic Factor by Gender and Sexuality

The Impact of Homophobia and HIV Stigma on HIV Testing Uptake Among Chinese Men Who Have Sex With Men

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