Search

Although HIV pre-exposure prophylaxis (PrEP) effectively and safely prevents HIV among adolescents, uptake of PrEP is low. Adolescents must have primary care providers (PCPs) prescribe them PrEP, making PCPs critical actors in PrEP delivery. However, research has primarily investigated determinants of PCPs' intention to prescribe adolescents PrEP rather than the determinants of performing the behavior itself. We examined the demographic, clinical practice, and implementation determinants of PCPs previously prescribing PrEP to adolescents. PCPs were recruited from a national Qualtrics panel of licensed medical providers in the United States from July 15-August 19, 2022. The Theoretical Domains Framework informed the implementation determinants measured. A multivariable logistic regression was used. PCPs who were more knowledgeable of the CDC guidelines (aOR 2.97, 95% CI 2.16–4.10), who were assigned male at birth (aOR 1.64, 95% CI 1.03–2.59), and who practiced in the Western region (aOR 1.85, 95% CI 1.04–3.30) had greater odds of prior prescribing adolescents PrEP. Provider-based educational interventions should be designed, implemented, and tested to encourage PCPs to prescribe PrEP to eligible adolescents. [ABSTRACT FROM AUTHOR]

The article presents a study which examined U.S. men who have sex with men (MSM) and transgender women's behavioral changes and employed exposure mitigation strategies due to the monkeypox outbreak, as of August 26, 2022. Topics discussed include how monkeypox is transmitted, sociodemographic characteristics of the sample, and change in the sexual behaviors of the participants due to the monkeypox outbreak.

Introduction: The United States (U.S.) has higher rates of sexually transmitted infections (STIs) and adolescent pregnancy than most other industrialized countries. Furthermore, health disparities persist among racial and ethnic minority adolescents (e.g., African American and Latinx) and in counties located along the U.S.--Mexico border region--they demonstrate the highest rates of STIs and unintended pregnancy among adolescents. Methods: Qualitative data were collected as part of formative research for the development of a mobile app that provides gender-inclusive sexual education to adolescents living in the U.S.--Mexico border region. From August 2019 to March 2020, the study team conducted 11 in-depth interviews with healthcare providers and three focus groups with cisgender, heterosexual, and SGM adolescents ages 15-18 (n = 20). Results: Providers and adolescents reported similar barriers to accessing SRH in this region such as transportation, lack of insurance and cost of services or accessing services without their parent's knowledge. However, providers shared that some adolescents in this region face extreme poverty, family separation (i.e., parent has been deported), have a mixed family legal status or are binational and have to travel every day from Mexico to the U.S. for school. These challenges further limit their ability to access SRH. Conclusions: Adolescents in the U.S.-Mexico border region face unique economic and social challenges that further limit their access to SRH care, making them uniquely vulnerable to STIs and unintended pregnancy. The prototype of the app was developed based on the needs expressed by providers and adolescents, including providing comprehensive Sex Ed and mapping of free comprehensive and confidencial SRH services available in the region and is being pilot tested. Our findings provide further evidence for the need for interventions and service delivery, programs tailored for residents in the border region. [ABSTRACT FROM AUTHOR]

Background: College students residing in rural areas of the United States have limited access to human immunodeficiency virus (HIV) and sexually transmitted infection (STI) screening programs; yet, have increased rates of infection.Methods: Students (N = 326), attending a state university located within a rural community, completed an online survey containing open-ended questions that gauged their perceptions and experiences with HIV/STI testing, amenability to at-home testing technology, and preferences for obtaining at-home testing kits. Inductive coding was used to create themes for each open-ended question.Results: Students encounter a number of perceived barriers to accessing clinical HIV/STI testing venues including cost, utilization of parents' medical insurance, and stigma. Students desired screening paradigms that allow for a greater sense of privacy and the ability to be empowered through self-sampling methods. This includes the use of at-home testing kits, which could be accessed via mail, campus, or the local community. Although students were overwhelmingly amenable to using at-home testing, students discussed concerns with potential user error that could impact testing accuracy.Conclusions: Study findings suggest the importance of developing less clinically oriented systems of HIV/STI screening, which allow students to choose from an array of screening options. Removing perceived barriers, notably access and privacy concerns, to HIV/STI testing by leveraging at-home testing is one potential method to increase screening uptake among this at-risk population. [ABSTRACT FROM AUTHOR]

Although men who have sex with men (MSM) within rural communities are disproportionately impacted by HIV, limited HIV research and programmatic resources are directed to these communities within the U.S. There is a need for improved behavioral data collection methods to obtain more detailed information on the relationship between rural environments, sexual behavior, and substance use. Utilization of mobile health (mHealth) technologies, such as ecologic momentary assessment (EMA), has been advocated for; however, limited research has evaluated its utility among rural MSM. Forty MSM residing in rural Oklahoma were recruited to complete in-depth interviews related to participating online/mobile-based HIV prevention research. Men described a willingness to participate in HIV and substance use studies that use EMA methodologies for data collection; however, they raised various research-related concerns. In particular, participants indicated potential privacy and confidentiality concerns related to the use of the mobile technology-based EMA in public and the storage of data by researchers. Given the varying degree of sexual orientation and substance use disclosure by participants, rural MSM were largely concerned with being inadvertently "outed" within their communities. Men described the various strategies they could employ to protect private information and methods to minimize research risk. Study findings suggest that EMA is an acceptable research methodology for use among rural MSM in the context of HIV and sexual health information, when privacy and confidentiality concerns are adequately addressed. Input from community members and stakeholders is necessary to identify potential areas of concerns for participants prior to data collection. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) efficacy in preventing HIV among gay, bisexual, and other men who have sex with men (MSM) is dependent upon adherence. Little is known about the PrEP adherence experiences among MSM who live in rural areas of the US. This qualitative study was informed by a modified version of Straussian Grounded Theory. Thirty-four 34 rural Midwestern MSM participated in telephone interviews that assessed their PrEP adherence factors. Overall, participants adhered to the PrEP regimen, ranging from missing none to a couple of doses per month. Participants had high self-efficacy (competence) and self-reliance (autonomy) in taking PrEP daily. Participants incorporated PrEP into their already existing routines. Participants were motivated to adhere to prevent HIV acquisition and be financially responsible. All participants mentioned their PrEP provider discussed the importance of adherence with PrEP's effectiveness, but future patient-provider PrEP adherence communication varied among participants. Future PrEP adherence interventions should address counseling strategies that leverage these constructs to support pill taking. Future research should explore patient-provider conversations surrounding PrEP adherence to inform provider- and patient-level interventions. [ABSTRACT FROM AUTHOR]

Despite the national HIV and sexually transmissible infection (STI) rates growing in rural areas, rural populations—particularly men who have sex with men (MSM), have limited access to secondary (i.e., HIV/STI screening) prevention activities compared with their urban counterparts. We conducted semistructured in-depth interviews with 23 rural MSM residing in Oklahoma and Arkansas to assess their (1) experiences with HIV and STI testing; (2) perceptions of at-home testing; and (3) preferences for receiving results and care. Barriers to accessing HIV/STI screening included lack of medical providers within rural communities, privacy and confidentiality concerns, and perceived stigma from providers and community members. To overcome these barriers, all participants recognized the importance of screening paradigms that facilitated at-home screening, medical consultation, and care. This included the ability to request a testing kit and receive results online, to access affirming and competent providers utilizing telemedicine technology, as well as prompt linkage to treatment. These narratives highlight the need for systems of care that facilitate HIV and STI screening within rural communities, which do not require participants to access services at traditional physical venues. [ABSTRACT FROM AUTHOR]

Facilitators and barriers of Pre-exposure Prophylaxis (PrEP) uptake have been established in prior studies; however, most of these studies comprise samples of MSM from metropolitan cities and hypothetical PrEP use. There is a dearth of literature on the uptake factors among rural U.S. MSM who are prescribed PrEP. Thirty-four rural Midwestern MSM who currently take PrEP participated in semi-structured telephone interviews about their barriers and facilitators to their PrEP use. Interviews were analyzed using an inductive thematic analysis approach. There were four barriers: (1) lack of rural dissemination of PrEP information, (2) concern about side and adverse effects of using PrEP, (3) cost of PrEP uptake and engagement, and (4) lack of access to PrEP care and PrEP care quality. Individual and social facilitators that participants utilized to overcome these barriers are discussed. Findings elevate the importance of multilevel interventions that address PrEP adoption from a patient, provider, and healthcare system perspective. [ABSTRACT FROM AUTHOR]

Most pre-exposure prophylaxis (PrEP) research samples men who have sex with men (MSM) who live in metropolitan cities. There is a limited understanding of the PrEP experiences among rural MSM. Thirty-four semi-structured interviews were conducted to explore the PrEP health care experiences among 34 rural Midwestern MSM. Of the 34 participants, 23 obtained PrEP from their non–primary care provider (PCP). Three themes were present: (1) PrEP is unavailable in rural areas, (2) PrEP is inaccessible in rural areas due to PCPs being unwilling to prescribe PrEP, and (3) PrEP services are unamicable in rural areas due to stigmatizing attitudes and behaviors of PCPs. It is important to address PrEP care continuum factors in all settings; however, these factors are often exacerbated in rural areas due to social determinants. Without further research and programming, organizational and social determinants may contribute to lower rates of PrEP outcomes in rural areas. [ABSTRACT FROM AUTHOR]

Previous models of sexual minority orientation identity development have theorized disclosure of current orientation as important in accepting one's sexual minority identity. Furthermore, research into disclosure of sexual orientation highlights positive outcomes for disclosure and negative outcomes for concealment of sexual minority identity. These models, however, fail to incorporate the socio-cultural context of the individual. Using a grounded theory approach, we conducted 40 interviews with individuals who identified with a sexual minority identity living in rural areas in Oklahoma, a primarily socio-politically conservative state in the U.S. Data collection continued until thematic saturation was reached. Three main themes were identified by participants in regards to navigating disclosure of sexual orientation: (1) assessment of consequences to disclosure; (2) situational disclosure of sexual orientation; and (3) disclosure of current sexual orientation. Rural sexual minority men navigate disclosing their sexual orientation by considering the socio-cultural environment where they live and the acceptance and/or rejection of important individuals in their lives. This consideration demonstrates the importance of considering disclosure as a step in sexual minority identity development, not actual disclosure of sexual minority identity. A preliminary model of navigating disclosure is proposed and implications are discussed. [ABSTRACT FROM AUTHOR]

Background: Research shows individuals experiencing adverse childhood experiences (ACEs) as well as identifying as a man who has sex with other men (MSM) are at an increased risk for mental health issues. Less has been studied, however, on ACEs in MSM; with even fewer studies investigating non-urban (e.g., rural/small town/suburban) MSM, as most research features urban samples. This is problematic due to studies showing that rurality can influence the behavior of MSM. The current study comparatively investigates the impact of ACEs on the mental health of rural/small town/suburban and urban MSM.Methods: Participants included 156 MSM residing in Oklahoma. Linear regression was used to test the association between ACEs' and mental health (anxiety, depressive symptoms, and loneliness). Split-sample regressions were conducted on rural/small town/suburban and urban MSM.Results: ACEs were associated with all three mental health outcomes in the full sample. However, ACEs were significantly linked to anxiety and depressive symptoms only in urban MSM.Limitations: Limitations include a smaller sample size with limited racial/ethnic variations.Conclusions: Results suggest that living in an urban environment may amplify the risks of ACEs, rural/small town/suburban MSM may acquire outside, unique support networks which work to limit the effect of ACEs, or that rural/small town/suburban MSM may manifest the effects of ACEs differently (or a combination of the three). Trauma-informed programming has been shown to effectively reduce mental health issues, yet consideration is generally not given with regards to rurality. Future programming and research should consider rurality/urbanity as influential factor. [ABSTRACT FROM AUTHOR]

Rates of sexual assault and sexual violence among college-aged adults are much higher than the national rates of sexual assault and sexual violence. Therefore, reduction and prevention of sexual violence among university students is critical and is consistent with national public health priorities. Often times, messages to students focus only on sexual assault and omit larger notions of sexual health. Four focus groups with a total of 24 participants (nine men, 15 women) highlighted three main perceptions about the sexual assault programming offered at this large university: themes of resistance to traditional programming, a need for holistic sexual health programming, and a desire to have an environment, which normalizes conversations surrounding sex, sexuality, and sexual health. [ABSTRACT FROM AUTHOR]

Given the dearth of research exploring mental health differences between rural and urban men who have sex with men (MSM), we sought to examine differences in depressive symptomology and loneliness. Concurrently we examined the mediating effects of loneliness on the link between geographic locale and depressive symptoms via a mediation model. Data were collected from 156 MSM in Oklahoma. Results show urban MSM have significantly higher levels of both depressive symptomology and loneliness. Mediation analyses revealed that the link between urban/rural locale and depressive symptomology was mediated by loneliness. In other words, identifying as urban MSM may result in higher levels of depressive symptomology through feelings of loneliness. The rationale for this includes the possibility that rural MSM may have strong online social support 'networks' which act as a protective factor against loneliness and depressive symptomology, or that elements of urban environments increase stress in urban MSM. It is also possible that the urban landscape of Oklahoma does not provide the same level of acceptance as other urban areas in more liberal parts of the country. Interventions at the individual or community level should consider geographic location as a mesosystem factor that impacts the mental health of MSM. [ABSTRACT FROM AUTHOR]

Little is known about motivations of adults who sext their relationship partners. Participants (N = 126, 71 male) completed an online questionnaire to assess their motivations for sexting their current relationship partner(s). The results of a MANOVA indicated the overwhelming motivation was to initiate sexual behaviors for all groups. Other motivations of instrumental/aggressive reasons were significantly higher for heterosexual men, and body image reinforcement was significantly higher for sexual-minority men. With results indicating the main motivation to sext was to initiate sexual behaviors, the potential of using sexting as an intervention to increase sexual intimacy in relationships is discussed. [ABSTRACT FROM AUTHOR]

Background: Past research identified individuals who experienced adverse childhood experiences (ACEs) are at a higher risk of drug use. There is evidence to suggest that identifying as a man who has sex with other men (MSM) may increase the likelihood of drug use when adverse childhood experiences are prevalent. However, research has not addressed if this association is present in both rural and urban MSM, as other studies found that rurality/urbanity is a key determinant in detrimental outcomes for MSM. The current study uses ACEs as an independent variable in comparing rural and urban MSM's self-reported marijuana use.Methods: Participants included 156 MSM residing in Oklahoma. Linear regression was used to test ACEs' associations with reported marijuana use. To explore nuanced differences between rural and urban populations, split sample regressions were conducted.Results: ACEs were statistically associated with reported marijuana use in the full sample. However, after splitting the sample, ACEs only predicted reported marijuana use in the urban and not in the rural sample.Conclusions: Results suggest ACEs may affect rural and urban MSM dissimilarly. It is unclear, however, if rural MSM engage in maladaptive behaviors other than marijuana use, or if factors associated with urban environments make urban MSM more vulnerable to illicit drug use when ACEs are high. Regardless, trauma informed programming targeting MSM should consider geographic locale as an influential factor. Further investigation is needed with regards to geographic locale, ACEs, and other illicit drug use in MSM populations. [ABSTRACT FROM AUTHOR]

Rural men who have sex with men (MSM) are particularly vulnerable to HIV/STI infections, though most outreach efforts to reach MSM have been focused on urban populations. More attention is needed to study effective ways of reaching/recruiting rural MSM, yet little is known about their preferences; particularly as studies show significant differences in the behaviors and perceptions of rural versus urban MSM. Our study uses a qualitative instrument to gauge what outreach methods are most effective from the perspective of 40, rural MSM. Outreach facilitators included online marketing, emphasizing rural areas, while outreach barriers included traditional forms of print media/advertising, or anything that may jeopardize anonymity. Implications for future outreach in rural areas and limitations are also discussed. [ABSTRACT FROM AUTHOR]

Higher levels of loneliness in men who have sex with men (MSM) are associated with negative outcomes such as depression, anxiety, and sexual impulsivity. By identifying what may reduce loneliness in MSM, counselors and public health professionals can alleviate the distress of their clients. A significant hierarchical multiple regression controlling for relationship status, F(9, 105) = 16.36, p < 0.001, R2 =.62, indicated that higher levels of self-forgiveness (β = −.19, p = .04) and perceived social support (β = −.49, p < .001) predicted lower levels of loneliness in MSM. Implications and limitations are discussed. [ABSTRACT FROM AUTHOR]

The information shared in schools on sex education in the USA is highly variable depending on the state and sometimes city in which a student lives. Gay and bisexual students living in a socially conservative, primarily rural state such as Oklahoma often receive little information about sexual health information that pertains to their behaviours unless it is discussing the dangers of sex. Using a qualitative approach, 20 gay and bisexual men currently residing in Oklahoma completed semi-structured interviews about their experiences with sex education and alternate ways to compensate for lack of information provided. Participants noted an awareness of the lack of meaningful sex education or if it was offered, a primary focus on abstinence-only until marriage heteronormative curricula. Participants described various ways they compensated for lack of sex education including accessing pornography and information from the internet. With the current socio-political environment of Oklahoma, it is unlikely wholesale changes to the sex education curricula can be made. The importance of public health professionals using the internet and peer educators to deliver inclusive and informative sexual health information remains salient and viable for men who reside in socio-politically conservative areas like Oklahoma. [ABSTRACT FROM PUBLISHER]

Purpose:This study aimed to determine what predicts a man who identifies as MSM living in a conservative state to inform his provider of his sexual behaviors and/or his sexual orientation.Methods:We administered an anonymous online survey to 148 men who reported seeing a general medical provider in the last 12 months. All participants resided in Oklahoma.Results:When controlling for HIV status, previous STI diagnosis, and age, logistic regression modeling yielded significant results (x2(9) = 31.22,p<.001) predicting 70.3% of cases. Age and overall disclosure of sexual orientation and/or sexual behaviors were significant predictors.Conclusion:Individuals who did not disclose their sexual orientation or same-sex behaviors to friends and family members were less likely to inform their providers of their sexual orientation. Disclosure of MSM status provides additional opportunities to enhance primary and secondary prevention strategies in rural and conservative areas that are necessary to optimize health, including but not limited to HIV screening and discussion of pre-exposure prophylaxis that their counterparts in urban settings more readily receive. [ABSTRACT FROM PUBLISHER]

Since few researchers have analyzed sexting behaviors in nonuniversity-based adult samples, we sought to determine if sexting is associated with negative psychological correlates and risky sexual behaviors in this population. Analysis of individuals who indicated having vaginal or anal sex in the past 12 months and who identified as single (n = 377) showed that condomless sex is independent of sexting behaviors. Results for those in committed relationships (n = 374) and having had vaginal or anal sex in the past 12 months also demonstrated condomless sex and sexting behaviors were not related. Furthermore, alcohol consumption and relational health were predictive of sexting behaviors in adults in committed relationships. These findings demonstrate that while risky sexual behavior and negative psychological correlates are associated with sexting and younger populations, the same might not be true for a nonuniversity-based, older adult sample. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To understand the comparative concerns and perceptions of veterinary and medical health professionals regarding antimicrobial resistance (AMR) and its effects on their clinical practices. SAMPLE: 17 Doctors of medicine and veterinary medicine and 1 nurse practitioner were interviewed to collect qualitative-based data regarding their clinical experience with AMR. METHODS: The interviews from the health professionals were transcribed and thematically coded to reveal 3 overarching themes and 7 corresponding subthemes. RESULTS: Both veterinary and human medical health professionals share concerns about antimicrobial resistance, specifically regarding the development of "superbugs" and increased difficulty in treating disease. However, there were some unique differences in the clinical effects of AMR between the professions in relation to client demand and satisfaction, ability to track/test trends, and approaches to therapy. Both professions also discussed the possible one-health implications of AMR and its transmission. CLINICAL RELEVANCE: There are several barriers to veterinarians that prevent them from using best-practice methods with antimicrobials that were not shared with human medical personnel, who can use antibiotic stewardship principles and readily access necessary testing. However, many veterinarians possessed a unique one-health-based understanding of how antimicrobial resistance can affect the wider community across species and globally that many human medical professionals had not previously considered. This demonstrates an increased need for one-health understanding within human medical professionals and a need for veterinarians to have access to necessary tools to comply with stewardship guidelines, such as culture and sensitivity testing and antibiograms, to have the ability to limit their contribution to antibiotic resistance. [ABSTRACT FROM AUTHOR]

Biomedical intervention approaches, including antiretroviral pre-exposure prophylaxis (PrEP), have been demonstrated to reduce HIV incidence among several at-risk populations and to be cost effective. However, there is limited understanding of PrEP access and uptake among men who have sex with men (MSM) residing in relatively rural states. Twenty semistructured interviews were conducted (August-November 2016) to assess opinions of and perceived barriers to accessing and adopting PrEP among MSM residing in Oklahoma. Participants perceived substantial barriers to accessing PrEP including a stigmatizing environment and less access to quality, LGBT-sensitive medical care. Overall, geographic isolation limits access to health providers and resources that support sexual health for Oklahoma MSM. Addressing stigma situated across ecological levels in an effort to increase adoption of PrEP by MSM residing in rural states remains necessary. Without this, social determinants may continue to negatively influence PrEP adoption and sexual health outcomes. [ABSTRACT FROM AUTHOR]

Sexting, defined as the sending and receiving of sexually suggestive or sexually explicit text or photos, has been growing in prevalence. Recent studies have demonstrated that over half of individuals sampled over 17 and regardless of gender participate in some type of sexting behavior. Most studies on sexting behaviors, including those looking at men who have sex with men (MSM) focus on emerging adult or university-based populations. The goal of the current study was to sample a nonuniversity-based MSM adult population to determine the prevalence of sexting behavior and the odds that a person engages in sexting behaviors based on certain sexual behaviors. The sample consisted of 213 MSM (mean age = 34.8 years, standard deviation [STD] = 12.1) who reside in Oklahoma. The majority of participants (133, 62.4 percent) participated in sexting behaviors. Logistic regression indicated that individuals had 10 times higher odds to engage in sexting if they had participated in a hookup (odds ratio [OR] = 10.44, 95% CI = [4.16-26.25]) and individuals who are married or in a committed relationship had 71 percent lower odds that they had sent a sext message (OR = 0.29, 95% CI = [0.12-0.71]). Sexting behaviors were not associated with condom use. Implications, including using third-party geolocation mobile application (such as Grindr) to deliver sexual health information, are discussed. [ABSTRACT FROM AUTHOR]

Previous research on sexual practices and commitment to monogamy of individuals has primarily been conducted on populations who endorse traditional sexual orientation labels of heterosexual, bisexual, and homosexual. Recent studies, however, demonstrate 16% of men and 37% women demonstrate some form of non-heterosexual attraction, behaviour, or fantasy although they endorse a heterosexual orientation status. The present study explored the impact of attitudes towards monogamy and casual sex for individuals who endorse non-heterosexual impulses but a heterosexual sexual orientation. A sample of 1,614 heterosexual men and women completed a voluntary questionnaire about sexual orientation, attraction, behaviours, and their attitudes towards casual sex and monogamy. Results revealed individuals who reported non-heterosexual sexual impulses endorsed increased acceptance of non-monogamous behaviour and increased acceptance of casual sex. Findings demonstrate the importance of providing education to clients about sexual orientation development, as well as ensuring that mental health providers and researchers alike do not force traditional labels of sexual orientation onto individuals. Furthermore, results indicate counsellors should establish a framework to engage couples and individuals in discussing their desires for casual sex and non-monogamy in an environment which is both accepting and understanding of that person’s experience. [ABSTRACT FROM AUTHOR]

Extant research on quality of life in gay, bisexual, and other men who have sex with men (MSM) primarily capture the social milieu and psychosocial outcomes of those living in urban rather than rural settings. Much of this can be attributed to the high demand for services in areas with greater concentrations of sexual minorities. As MSM in rural communities are both underrepresented in research and susceptible to social estrangement from each other, our study assessed the impacts of several aspects of their social milieu—recency of access to community resources for gay/bisexual men and time socializing with other gay/bisexual men—on loneliness, as well as the mediating role of perceived connectedness to the local gay/bisexual community on this association. Using purposive sampling and Internet-based direct marketing, we recruited 225 MSM aged 18 or older in rural and mixed rural areas in south-central Indiana. We performed a path analysis to test our hypothesized model. Recency of access to community resources was positively associated with perceived connectedness to the gay/bisexual community, which in turn was protective against loneliness. Findings indicate that improving accessibility to venues or activities for rural MSM could serve to facilitate community-building and benefit their psychosocial well-being. [ABSTRACT FROM PUBLISHER]

Although research on childhood gender nonconformity (CGN) has shown to be the only consistently correlated measure with adult self-identification of sexual orientation for men and women, little research has focused on other dimensions of sexual orientation are also correlated with CGN. In an online survey of adults (N = 2,372), information on participants’ self-identified sexual orientations, sexual attractions, sexual behaviors, and sexual fantasies correlated with recalled CGN. The only significant predictor that an adult would recall CGN behaviors was sexual attraction. Implications of the findings as well as limitations to the current study are discussed. [ABSTRACT FROM PUBLISHER]

Most previous studies of the sexual behaviour of gay, bisexual and other men who have sex with men living with HIV are based on samples of men recruited within relatively urban and suburban areas of the USA. The aim of the present study was to explore the potential challenges associated with HIV-related stigma and residing in a relatively rural area. We conducted a qualitative study based in south-central Indiana, a relatively rural area of the USA. Twenty-three HIV-positive gay, bisexual and other men who have sex with men, aged 21–48 years, were interviewed on topics regarding community engagement, perceived HIV-related stigma, relationship formation, sexual behaviour and HIV status disclosure. Findings indicate HIV-related stigma is commonly reported at the interpersonal and community levels. Because of this, men face complex situations on how and when to disclose their HIV status to members of their social and sexual networks. Although many participants reported many challenges associated with relationship formation, all expressed a desire for romantic and/or sexual connections with other men and/or women. Results suggest that new programmatic approaches are necessary to inform the work of social service and medical providers on mechanisms to intervene and combat stigma and discrimination inherent in communities, programmes and policies. [ABSTRACT FROM PUBLISHER]

Most previous studies of the sexual behaviors of men who have sex with men (MSM) living with HIV are based on samples recruited within relatively urban and suburban areas of the United States. Using an internet-based questionnaire, we assessed HIV-related stigma, loneliness, and event-level sexual behaviors in a sample of HIV positive MSM ( n = 100) residing within a largely rural area in the Midwestern United States. HIV-related stigma was correlated with loneliness ( r = 0.619, p < 0.01). Loneliness was negatively associated with condom usage with the most recent partner of unknown status ( p < 0.05). Namely, a 1-unit increase in the UCLA loneliness score was met with a 10% decrease in odds of condom usage. Further studies are warranted that explore loneliness, within the context of HIV-related stigma, among HIV-positive MSM residing in rural areas. More refined data will inform clinical and social service practice, as they provide much-needed information on sexual health outcomes and experiences of an often underserved and under studied population. [ABSTRACT FROM AUTHOR]

Most previous studies of the sexual behaviors of men who have sex with men (MSM) living with HIV are based on samples recruited within relatively urban and suburban areas of the United States. Using an internet-based questionnaire, we assessed HIV-related stigma, loneliness, and event-level sexual behaviors in a sample of HIV positive MSM ( n = 100) residing within a largely rural area in the Midwestern United States. HIV-related stigma was correlated with loneliness ( r = 0.619, p < 0.01). Loneliness was negatively associated with condom usage with the most recent partner of unknown status ( p < 0.05). Namely, a 1-unit increase in the UCLA loneliness score was met with a 10% decrease in odds of condom usage. Further studies are warranted that explore loneliness, within the context of HIV-related stigma, among HIV-positive MSM residing in rural areas. More refined data will inform clinical and social service practice, as they provide much-needed information on sexual health outcomes and experiences of an often underserved and under studied population. [ABSTRACT FROM AUTHOR]

Semistructured interviews were completed with a sample of 25 men residing in an urban area of the Midwestern United States to elicit preferred methods of sexually transmitted infection service delivery. Results highlight the influence of stigma, social support, and perceived risk on sexually transmitted infection screening uptake and preferred methods of screening. [ABSTRACT FROM AUTHOR]

In this study we used grounded theory methodology to understand the influence of loneliness in YMSM in terms of HIV risk behavior. Twenty-two YMSM, 18–29 years of age, of HIV-negative/unknown status were interviewed. Results indicated that loneliness is defined in two ways: emotional and social. A cyclical pattern emerged that included negative symptoms, “self-treatment” of loneliness through drug use and sex, temporary relief, remorse related to engaging in HIV risk behaviors, negative self-image, and ultimately the reemergence of initial loneliness symptoms. Results suggest that loneliness in YMSM plays a greater role in HIV-related behavior than previously understood. A preliminary explanatory model, implications, and directions for future research are discussed. [ABSTRACT FROM PUBLISHER]

Objective: To explore experiences, beliefs, and information-seeking behavior around COVID-19 among college students in Oklahoma. Participants: Fifteen college students participated during the pandemic period from April to July 2020. Methods: An exploratory, qualitative research approach method was used to discover students' experiences, beliefs, and information-seeking behaviors around COVID-19. Exploration of beliefs was guided by the Health Belief Model. Results: Students engaged in COVID-19 information-seeking behaviors predominantly through Internet sites, broadcast news, health professionals, and governmental sources. Students experienced emotional burden as a result of COVID-19 misinformation in these sources. While most students perceived a low chance of acquiring the virus due to their lack of underlying medical conditions, they were still concerned about the consequences of becoming infected. Students noted the difficulty of physical distancing while on campus. Conclusions: Colleges/universities should maximize the dissemination of timely, valid health information for the safety of their students and the broader community. [ABSTRACT FROM AUTHOR]

Because most parent-adolescent sex communication studies are from the perspectives of sexual and gender minority (SGM) adolescents rather than their parents, we surveyed 54 parents of SGM adolescents in the Southern region in the U.S. about their HIV-related parent-adolescent sex communication (PASC) practices. We compared topics discussed between the sexual activity and sexual orientation/gender identity of their adolescent. We found significant differences between parents having a sexually-active adolescent or not and parents discussing the importance of using condoms and what their adolescent should do if the adolescent contracts HIV. We provide future directions to further examine and improve PASC between parents and their SGM adolescents. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic thrust people living with HIV (PLWH) and HIV/AIDS service organizations into an environment ripe with uncertainty. This study examined Indiana HIV/AIDS service provider perceptions of how COVID-19 affected the overall health and access to care of their clients, and how the organizations prepared for, adapted, and responded to the needs of PLWH during the pandemic. Methods: Guided by the socioecological model, fifteen semi-structured interviews were conducted with ten different HIV/AIDS service organizations across the state of Indiana. Results: Despite the profound disruptions experienced by HIV programs, HIV/AIDS service organizations responded quickly to the challenges posed by the COVID-19 pandemic through myriad innovative strategies, largely informed by prior experiences with the HIV epidemic. Conclusions: The lessons provided by HIV/AIDS service organizations are invaluable to informing future pandemic response for PLWH. Service delivery innovations in response to the COVID-19 crisis may provide insights to improve HIV care continuity strategies for vulnerable populations far beyond the pandemic. [ABSTRACT FROM AUTHOR]

Adverse Childhood Experiences (ACEs) show predictive utility concerning binge drinking. However, the literature is limited by 1. a focus on cumulative ACEs with little regard to specific domains, 2. a focus on those with the highest ACE scores, and 3. little consideration for gender differences. These approaches are problematic as ACE categories are fundamentally different, yet little distinction is given to specific ACE domains. The current study investigates which individual and dual ACE domain combinations are associated with binge drinking. Data were obtained from the Behavioral Risk Factor Surveillance System (2011-2017; N = 80,391). A series of ANCOVAs were conducted to determine the association between single and dual combination ACE domains and binge drinking. Results show gendered effects of ACEs on binge drinking such that at 0, 1, and 2 ACEs, males reported statistically higher rates. For males with exactly two ACEs, combinations of either sexual abuse or family incarceration presented the highest levels of binge drinking- with the highest mean binge drinking score being the exact combination of the two. This contrasts with males with 1 ACE, where experiencing family incarceration or sexual abuse, as a single domain, did not represent significant risk above the average of having a single ACE. Results suggest that males may be resilient to either of these domains as singular events, yet when found in combination, may present a synergistic effect that increases the likelihood of binge drinking. Due to lower overall binge drinking rates, no significant patterns were found among females. [ABSTRACT FROM AUTHOR]

Background: Adversity experienced during childhood manifests deleteriously across the lifespan. This study provides updated frequency estimates of ACEs using the most comprehensive and geographically diverse sample to date.Methods: ACEs data were collected via BRFSS (Behavioral Risk Factor Surveillance System). Data from a total of 211,376 adults across 34 states were analyzed. The ACEs survey is comprised of 8 domains: physical/emotional/sexual abuse, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation/divorce. Frequencies were calculated for each domain and summed to derive mean ACE scores. Findings were weighted and stratified by demographic variables. Group differences were assessed by post-estimation F-tests.Results: Most individuals experienced at least one ACE (57.8%) with 21.5% experiencing 3+ ACEs. F-tests showed females had significantly higher ACEs than males (1.64 to 1.46). Multiracial individuals had a significantly higher ACEs (2.39) than all other races/ethnicities, while White individuals had significantly lower mean ACE scores (1.53) than Black (1.66) or Hispanic (1.63) individuals. The 25-to-34 age group had a significantly higher mean ACE score than any other group (1.98). Generally, those with higher income/educational attainment had lower mean ACE scores than those with lower income/educational attainment. Sexual minority individuals had higher ACEs than straight individuals, with significantly higher ACEs in bisexual individuals (3.01).Conclusion: Findings highlight that childhood adversity is common across sociodemographic, yet higher in certain categories. Identifying at-risk populations for higher ACEs is essential to improving the health outcomes and attainment across the lifespan. [ABSTRACT FROM AUTHOR]

The current study sought to explore the motivations adults have for engaging in sexting behaviours with their relationship partners. Previous research mainly focuses on emerging adult and adolescent populations. With estimates of adults engaging in sexting approaching 50%, the current study used a qualitative approach to analyse responses from participants about their motivations to sext their relationship partners. With 157 (79 male) valid responses, the majority (86) of respondents identified sex related reasons for engaging in sexting. However, a sizeable minority (50) identified a non-sex related reason of physical distance from their partner(s) as a motivation to sext. This unique finding highlights the benefit that individuals who are physically separated from their partners gain by engaging in sexting. Participants in the current study shared aspects of engaging in sexting that were similar to other motivations found in previous research on sexting, but they framed these within the construct of being physically separated from their relationship partner(s). The results imply that distance may be an underlying motivation for some adults who engage in sexting behaviours with their partner(s). [ABSTRACT FROM AUTHOR]

Primary care providers (PCPs) are critical in prescribing human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) to adolescents at risk of HIV. More research is needed to identify facilitators and barriers PCPs encounter in prescribing PrEP to eligible adolescents post-Food and Drug Administration (FDA) approval. This online cross-sectional survey examined the PrEP implementation facilitators and barriers among a national sample of PCPs in the United States. PCPs (n = 502) specializing in family medicine or pediatrics were recruited from a Qualtrics panel from July 15 to August 9, 2022. We analyzed the collected data using content analysis and applied the Expert Recommendations for Implementing Change (ERIC) to codebook creation and data analysis. We conducted a Fisher's exact chi-square test of independence to compare facilitator and barrier prevalence differences between participants who had and had not prescribed PrEP to an adolescent patient. Results demonstrate that (1) distributing prescriber-focused educational materials, (2) involving parents, (3) changing liability laws, (4) enhancing adolescent PrEP uptake and adherence, (5) changing clinical resources, and (6) using mass/social media to change community norms might be strategies that influence PCPs prescribing PrEP to eligible adolescent patients. Results from this study could facilitate the planning of hybrid implementation-effectiveness trials designed to determine the acceptability, feasibility, and effectiveness of implementation strategies in improving the practices of PCPs prescribing PrEP to at-risk adolescents. [ABSTRACT FROM AUTHOR]

This study investigated the intersectionality of adverse childhood experiences (ACEs) among subgroups of sex, race/ethnicity, and sexual orientation. Using data from the Behavioral Risk Factor Surveillance Survey across 34 states (N=116,712) from 2009 to 2018, authors stratified subgroups of sex (male/female), race/ethnicity (White/Hispanic/Black/multiracial/other), and sexual orientation (heterosexual/bisexual/gay) to investigate the number of ACEs across groups. Analyses were conducted in 2022. Stratification resulted in 30 distinct subgroups (e.g., bisexual Black females, straight multiracial males) with significant post hoc differences per group. Generally, those identifying as sexual minority individuals had the highest number of ACEs (the top 14 of 30 subgroups), whereas seven of the top ten subgroups were female. Surprisingly, no clear patterns emerged by race/ethnicity, although the two largest groups (straight White females and straight White males) were 27th and 28th of 30, respectively. Although studies have examined ACEs by individual demographic variables, less is known about the extent to which ACEs are present in stratified subgroups. Sexual minority subgroups (particularly female bisexual subgroups) trend toward a higher number of ACEs, whereas heterosexual subgroups (regardless of sex) comprised the lowest 6 groups with respect to ACEs. Implications include further examination of bisexual and female subgroups (including specific ACE domain investigations) to identify the vulnerable population. [ABSTRACT FROM AUTHOR]

Although parents of sexual and gender minority (SGM) adolescents are key stakeholders in SGM adolescents using HIV pre-exposure prophylaxis (PrEP), there is limited understanding of parental concerns and attitudes about their SGM adolescents taking PrEP. Fifty-four parents in the West South Central region of the U.S. completed an online, mixed-method, cross-sectional questionnaire to explore their concerns and questions about PrEP. Quantitative and qualitative results show that participants were more concerned about side effects, drug interactions, (non)adherence, and eligibility and duration of PrEP. Parents are less worried about picking PrEP from a pharmacy or returning to follow-up lab testing every three months. Most parents reported receiving medication information their adolescent takes from a medical provider and the media. Findings from this study can inform the development of parent-based PrEP interventions. Without further parent-based research and programming, SGM adolescents may continue to be disproportionately affected by HIV. [ABSTRACT FROM AUTHOR]

HIV service providers are the primary implementers of HIV care services, but rural HIV service providers are under researched. We used an interpretative phenomenological analysis to explore rural HIV service providers' lived experiences of working in HIV care, who work in a rural region of a Midwestern state in the United States. From July to August 2019, 15 HIV service providers participated in a one-hour semi-structured telephone interview that elicited their experiences working in the rural HIV care continuum. Participants were tired of constantly educating and working to reduce HIV stigma; however, they received support from family and friends once they educated them about HIV. Participants felt they lacked control over systems and they developed emotional-based coping to address constant occupational stressors. Findings highlight the importance of resiliency and advocacy research and practice across ecological levels. [ABSTRACT FROM AUTHOR]

Sexual minority men have consistently shown to be at-risk for adverse mental health outcomes due to minority stress, yet studies show some men successfully navigate these barriers. What is less known are the environmental and social/emotional factors to which minority stress is amplified (or attenuated). We comparatively investigate rural versus urban sexual minority men and how levels of 'outness' (the degree to which an individual discloses their sexual identity to others around them) interacts with gay-related rejection anxieties (a specific type of minority stress). Results broadly show that 1. higher levels of gay-related rejection are statistically associated with higher levels of loneliness, and 2. outness moderated this link in rural, but not urban men. In other words, higher levels of outness amplified the deleterious effects of gay-related rejection in the rural sample only. Although previous research shows mixed results in regards to how coming out affects the mental health of sexual minority men, our stratified results show that rural men may be at a higher risk for deleterious mental health with higher levels of outness. Implications from this study bolster the mental health field, particular mental health practitioners working with rural sexual minority men and the aftermath of coming out. [ABSTRACT FROM AUTHOR]

Co-occurring mental health (MH) problems are common among those with opioid use disorders (OUDs). However, most opioid treatment programs (OTPs) do not provide MH services. We measured the association between state level characteristics (Medicaid expansion status and rurality) and MH/OUD services integration. We used a generalized linear model to estimate how the association between integration and Medicaid expansions varied across levels of rurality (National Survey on Substance Abuse Treatment Services; 2018; n = 1507 OTPs). The predicted probability of OTPs offering MH services decreased as rurality increased, and the strength of the negative association was greater in non-expansion states (β =−0.038, SE = 0.005, p < 0.0001) than in expansion states (β =−0.020, SE = 0.003, p < 0.0001). Access to integrated MH services was lowest in rural non-Medicaid expansion states, despite the high risk of opioid misuse and a high need for MAT and MH services in this population. [ABSTRACT FROM AUTHOR]

Few studies have focused on within-group heterogeneity about specific factors that make lesbian, gay, or bisexual (LGB) Latinx adolescents at greater odds than other LGB adolescents for suicide We take a unique mixture-modeling approach by creating profiles of Latinx LGB adolescents based on suicide risk factors used in previous investigations (bullying, alcohol, sleep, social media, and poor grades). We use these profiles in a logistic regression to investigate suicidality A sample of 686 LGB, Latinx adolescents were used in a latent profile analysis yielding four distinct profiles. Class 4 represented the highest risk, with high rates of bullying, alcohol, poor grades, and use of electronics, while class 3 represented the lowest risk with low rates of bullying and alcohol Results speak to the need to address suicidal ideation through multiple factors, noting the strong association that both bullying and alcohol have with suicidal ideation. [ABSTRACT FROM AUTHOR]

This study explores the role of faith leaders and congregations in preventing teen pregnancy and enhancing overall health. Seventeen faith-based leaders responded to an invitation to participate. Participants were recruited from two counties within Oklahoma, based on desired community characteristics. Findings were directly related to: (1) the vulnerability of rural communities to negative health outcomes; (2) resiliency of rural faith communities to address health issues; and (3) the adaptive capacity of rural faith leaders and their communities to decrease teen pregnancy and maximize community health. Culturally relevant public health programming is necessary to engage this at risk population; however, it requires engaging faith leaders in efforts to build congregation-based and community-based capacity. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) uptake has been suboptimal despite its demonstrated efficacy in reducing the risk of HIV acquisition. Medical education is one distal determinant that shapes medical providers' perceived role in the PrEP care continuum. However, there is limited understanding of how osteopathic medical students and those wanting to practice in rural areas perceive their role in the PrEP care continuum in the domains of PrEP awareness, uptake, and adherence and retention. Twenty-one semistructured interviews were conducted (March 2019–April 2020) to assess what shapes osteopathic medical students' perceived role in the PrEP care continuum. Participants noted a lack of adequate sexual health training, personal perceptions concerning PrEP use, and ambiguity concerning which of the medical specialties should deliver PrEP. Osteopathic medical schools can incorporate more inclusive and holistic sexual health and PrEP curricula to address these barriers and better prepare osteopathic medical students for their future role in the PrEP care continuum. [ABSTRACT FROM AUTHOR]

Introduction: Adverse childhood experiences are linked to deleterious outcomes in adulthood. Certain populations have been shown to be more vulnerable to adversity in childhood than others. Despite these findings, research in this area lacks an empirical investigation that examines adverse childhood experiences among American Indian and Alaska Native populations using large, nationally representative data. As such, the authors have compiled what they believe is the largest empirical investigation of adverse childhood experiences among American Indian and Alaska Native individuals to date.Methods: Data were collected from the Behavioral Risk Factor Surveillance System from 34 states (2009-2017), whereby all individuals self-report as American Indian and Alaska Native (N=3,894). Adverse childhood experience scores were calculated and further stratified by sex, age, household income, education, employment status, sexual orientation, Census region, and state. In addition, frequencies and prevalence of each adverse childhood experience domain (stratified by the same categories) were calculated. Analysis was conducted in 2019.Results: The average adverse childhood experience score among American Indians and Alaska Natives was 2.32, higher than those of individuals identifying as White (1.53), Black (1.66), and Hispanic (1.63). Female participants had a higher average adverse childhood experience score than male participants (2.52 vs 2.12). Generally, younger individuals and those with lower incomes reported higher adverse childhood experience scores, whereas those with higher educational attainment reported lower scores.Conclusions: Compared with the few studies among American Indian and Alaska Native populations that have used either smaller samples or nontraditional adverse childhood experience data (i.e., asking parents about their children's experiences), these results present overall higher adverse childhood experience averages than previously published studies. Nevertheless, aligning with other research on adverse childhood experiences, female individuals, younger adults, and sexual minorities reported higher adverse childhood experiences scores than other categories in their respective demographics. [ABSTRACT FROM AUTHOR]

This community-based study explored the lived experiences of being in and going through the rural HIV care continuum among 15 gay and bisexual men (GBM) with HIV who live in a rural area of a Midwestern state. Our analysis adapted a six-step interpretative phenomenological analysis. Five themes emerged that reflected the five continuum stages: 1) Diagnosis means death, 2) Linkage to care means uncertainty, 3) HIV care improves the quality of life lost pre- or peri-diagnosis, 4) ART implies life, and 5) Undetectable addresses the medical but not social aspects of HIV. Participants recalled they faced and continue to face social determinants, stigma, and chronic and mental health conditions. Findings provide future research directions and practical implications to address social determinants of health, promote chronic and mental health, and reduce interpersonal stigma throughout all HIV care continuum stages. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses healthcare facilities, social work and counseling available for the lesbian, Gay, Bisexual, Transgender (LGBTQ) community.

Given that few researchers have addressed sexting among adult samples, we sought to evaluate the prevalence of adults who sext, their sexting behaviors, and how it impacted relationship satisfaction. Analyses on the sample (N = 1171) revealed that heterosexual women are negatively impacted if they do not reciprocate a sext message; yet nonheterosexual women, and men in general, are not negatively impacted. This finding can be best understood within the framework of relational cultural theory (RCT). Implications for future research and for the practice of mental health providers are discussed. [ABSTRACT FROM AUTHOR]