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Objectives. To determine whether intersectional stigma is longitudinally associated with biopsychosocial outcomes. Methods. We measured experienced intersectional stigma (EIS; ≥ 2 identity-related attributions) among sexual minority men (SMM) in the United States participating in the Multicenter AIDS Cohort Study. We assessed longitudinal associations between EIS (2008‒2009) and concurrent and future hypertension, diabetes, dyslipidemia, antiretroviral therapy adherence, HIV viremia, health care underutilization, and depression symptoms (2008‒2019). We conducted causal mediation to assess the contribution of intersectional stigma to the relationship between self-identified Black race and persistently uncontrolled outcomes. Results. The mean age (n = 1806) was 51.8 years (range = 22–84 years). Of participants, 23.1% self-identified as Black; 48.3% were living with HIV. Participants reporting EIS (30.8%) had higher odds of hypertension, dyslipidemia, diabetes, depression symptoms, health care underutilization, and suboptimal antiretroviral therapy adherence compared with participants who did not report EIS. EIS mediated the relationship between self-identified Black race and uncontrolled outcomes. Conclusions. Our findings demonstrate that EIS is a durable driver of biopsychosocial health outcomes over the life course. Public Health Implications. There is a critical need for interventions to reduce intersectional stigma, help SMM cope with intersectional stigma, and enact policies protecting minoritized people from discriminatory acts. (Am J Public Health. 2022;112(S4):S452–S462. https://doi.org/10.2105/AJPH.2022.306735 )

Background: Fatal and non-fatal events associated with drug misuse are skyrocketing in most United States jurisdictions, including Indiana. Historically, the role of the judiciary is to arrest, impose sanctions and protect society from harm. Adults arrested for drug abuse in Indiana can be sentenced to 1 of 17 correctional facilities. As an alternative, they may be eligible to participate in a problem-solving court (PSC) programme that refers individuals to treatment as a pretrial diversionary strategy. The aim of the study is to determine which interventions offered by PSCs and correctional facilities impact morbidity and mortality. The study began in 2019 and will end in 2023; therefore, the results in this manuscript are preliminary. Methods: The study cohort included two populations arrested for drug misuse: (1) adults sentenced to Indianan correctional facilities (1 January 2018 to 30 June 2021) and (2) adults participating in an Indiana PSC programme (1 January 2018 to 30 June 2021). The study used a mixed-methods design that integrated qualitative interviews of deputy wardens, PSC team members and service providers with the following quantitative datasets: sentencing information, emergency department visits, inpatient hospitalization admissions, prescription drug monitoring programme data and death records. The individuals will be followed at 2-week, 4-week, 6-month and 1-year intervals post-release. Difference-in-difference and time-toevent analyses will identify impactful interventions. A model will be created to show the effect of impactful interventions in Indiana counties that do not have PSCs. Results: Findings are preliminary. There is variability amongst correctional facilities regarding programme eligibility, provided services and provision of medication-assisted treatment. All correctional facilities were severely impacted by the COVID-19 pandemic. Conclusion: It is anticipated that the adoption of impactful interventions will lower opioid-related morbidity and mortality rates.

Objectives Connections to the gay community may elicit negative self-appraisals among men who have sex with men (MSM), which may be exacerbated for people with HIV (PWH). Fitness engagement may mediate self-appraisals by maintaining or improving appearance and health. We hypothesized that gay community connections would be positively related to negative self-appraisal and explored whether this association would be mediated by fitness engagement and moderated by HIV status. Method Data were obtained from the Multicenter AIDS Cohort Healthy Aging study (N = 1,026; PWH n = 525; people without HIV [PWOH] n = 501). Structural equation modeling (SEM) examined associations between gay community connections, negative self-appraisal (body image dissatisfaction, self-perception of aging), and fitness engagement (physical activity, motivation to be fit). Multiple-group SEM tested the moderating effects of HIV serostatus. Results The SEM fit the data well (root mean square error of approximation = 0.056; 90% CI: 0.046, 0.066). Connection to the gay community was inversely related to negative self-appraisals and positively related to fitness engagement. Fitness engagement mediated the association between community connections and negative self-appraisal and was inversely related to negative self-appraisals. Among PWH, the association between community connections and self-appraisal was weaker and the effect of fitness engagement on negative self-appraisal was stronger compared to PWOH. Discussion Connection to the gay community may be a source of resilience for aging MSM by lessening negative self-appraisals and promoting strategies that address body image dissatisfaction and self-perceptions of aging. Interventions facilitating connections to the gay community may support healthy aging in this population.

Background and Objectives Conversion therapies to minimize same-sex attractions are classified as a dangerous practice by numerous scientific institutions in the United States. These practices may contribute to poor long-term psychosocial health, thereby interrupting processes of healthy aging. Few studies have examined psychosocial differences between persons with and without prior experiences of conversion therapy. We assessed associations between prior conversion therapy experiences and psychosocial health among midlife and older men who have sex with men (MSM; age 40+ years). Research Design and Methods Participants included a multicity sample of MSM (N = 1,156) enrolled in the Multicenter AIDS Cohort Study who completed health surveys (2016–2019) as part of their biannual study visits. Using multivariable regressions, we investigated the associations of prior conversion therapy with current depressive symptoms, internalized homophobia, post-traumatic stress, and cumulative psychosocial conditions. Using a trait-level measure (e.g., life purpose and perseverance), we tested whether resilience moderated these associations. Results The full sample was predominantly non-Hispanic white with a mean age of 62.6 years. Fifteen percent of men (n = 171/1,156) reported prior conversion therapy. In multivariable models, men exposed to conversion therapy were more likely to have depressive symptoms and above-average internalized homophobia. Men exposed to conversion therapy had 2–2.5 times the odds of reporting 1 and ≥2 psychosocial conditions, respectively, compared with those who reported 0 conditions. Resilience did not moderate these associations. Discussion and Implications Conversion therapies are nonaffirming social stressors for MSM and may compromise critical psychosocial aspects of healthy aging among MSM.

This study investigated if homophobic and racist discrimination increased depressive symptoms among 960 middle-aged and older men who have sex with men (MSM) and how resilience moderated these relationships. We used five waves of longitudinal data from the Healthy Aging sub-study of the Multicenter AIDS Cohort Study (MACS). We used linear regression analyses to model depressive symptoms as a function of discrimination. We used linear mixed analyses to model changes in mean resilience scores across visits. We used linear regression analyses to model depressive symptoms as a function of changes in resilience and to test the moderation effects of resilience on the relationship between discrimination and depressive symptoms. The models accounted for repeated measures of resilience. Men who experienced external and internal homophobia had greater depressive symptoms (β: 2.08; 95% Confidence Interval: 0.65, 3.51; β: 1.60; 95% Confidence Interval: 0.76, 2.44). Men experienced significant changes in mean resilience levels across visits (F = 2.84, p = 0.02). Men with a greater positive change in resilience had lower depressive symptoms (β: −0.95; 95% Confidence Interval: −1.47, −0.43). Men with higher average resilience levels had lower depressive symptoms (β: −5.08; 95% Confidence Interval: −5.68, −4.49). Men’s resilience did not moderate the relationship between homophobia and depressive symptoms. Significant associations of external and internal homophobia with greater depressive symptoms present targets for future research and interventions among middle-aged and older MSM. Significant associations of average and positive changes in resilience with lower depressive symptoms provide aims for future research and interventions with this population.

Background and Objectives Older people have an increased risk of developing frailty, an age-related clinical syndrome associated with worse health outcomes. This study examined the effect of self-perception of aging (ie, age discrepancy—individuals feel younger/older than their chronological age and aging satisfaction) on frailty transitions. Research Design and Methods We use longitudinal data from 549 HIV−/499 HIV+ sexual minority men aged 50 years or older enrolled in the Multicenter AIDS Cohort Study. To test the association of self-perception of aging on transitions between states of frailty (nonfrail/frail), defined using Fried Frailty Phenotype, a multinomial modeling was used. Results With remaining nonfrail as the referent group, participants reporting low aging satisfaction (vs moderate aging satisfaction) had increased odds of transitioning from nonfrail to frail (odds ratio [OR]: 2.72; 95% confidence interval [CI]: 1.56–4.74), frail to nonfrail (OR: 3.40; 95% CI: 1.62–7.12), or remaining frail (frail to frail; OR: 6.64; 95% CI: 3.88–11.38). Participants reporting older subjective age (vs no age discrepancy) had increased odds of transitioning from nonfrail to frail (OR: 2.50; 95% CI: 1.11–5.64), frail to nonfrail (OR: 4.47; 95% CI: 1.85–10.81), or remaining frail (frail to frail; OR: 5.68; 95% CI: 3.06–10.56). High aging satisfaction and younger subjective age were not statistically associated with frailty transitions. Discussion and Implications Our findings show that negative self-perception of aging (ie, older subjective age and low aging satisfaction) is associated with frailty transitions (nonfrail to frail, frail to nonfrail, and frail to frail) when compared to remaining nonfrail.

Functional support—the availability of material aid, emotional support, or companionship—promotes general well-being. For men who have sex with men (MSM) living with HIV, having a person who supports you associates with viral suppression. This study examines the association between supportive partnerships and HIV viral suppression among middle-aged and aging MSM living with HIV. A total of 423 middle-aged and aging MSM (mean age, 58.2 years) from the Multicenter AIDS Cohort Study provided self-reported data about their partnerships. Separate Poisson regression models assessed how partnership type, support, strain, and duration from April 2017 were associated with repeated viral load measurements up to April 2019. Of the follow-up visits (N = 1289), 90.0% of participants were virally suppressed. Most participants reported being non-Hispanic White (61.0%) and college-educated (83.4%). Participants were asked about their primary partnerships (i.e., “someone they are committed to above anyone else”) and secondary partnerships (i.e., those who can also be intimate or supportive but not necessarily romantic or sexual). The participants reported: no partnerships (45.2%), only primary partnerships (31.0%), only secondary partnerships (11.1%), or both primary and secondary partnerships (12.8%). Primary and secondary partnerships had mean (SD) durations of 15.9 (11.3) and 25.2 (16.5) years, respectively. Participants reporting both primary and secondary partnerships (compared with no partnership) showed significantly higher odds of being virally suppressed (adjusted prevalence ratio [aPR], 1.04; 95% CI, 1.00–1.08; p = 0.043). Albeit not statistically significant, primary-only (aPR, 1.01; 95% CI, 0.97–1.06; p = 0.547) or secondary-only (aPR, 1.03; 95% CI, 0.98–1.08; p = 0.224) partnership types were positively associated with viral suppression. Partner support and strain were not associated with viral suppression in any partnership group. Being older and non-Hispanic Black were positively and negatively associated with viral suppression, respectively. Encouraging partnerships should be considered one of clinicians’ many tools to help middle-aged and aging MSM achieve long-term viral suppression.

BACKGROUND With the graying of sexual and gender minority communities and the growing number of people aged ≥50 years living with HIV, it is increasingly important to understand resilience in the context of the psychosocial aspects of aging and aging well. OBJECTIVE This paper aims to describe the methods and sample for the Understanding Patterns of Healthy Aging Among Men Who Have Sex With Men study. METHODS This observational cohort study was conducted within the Multisite AIDS Cohort Study (MACS) and was designed to explore resiliencies to explain patterns of health and illness among middle-aged and older sexual minority men. To be eligible, a participant had to be an active participant in the MACS, be at least 40 years of age as of April 1, 2016, and report any sex with another man since enrollment in the MACS. RESULTS Eligible participants (N=1318) completed six biannual surveys between April 2016 and April 2019. The mean age of the sample was 59.6 years (range 40-91 years). The sample was mostly White, educated, gay-identified, and included both HIV-positive (656/1318, 49.77%) and HIV-negative (662/1318, 50.23%) men. CONCLUSIONS Understanding resiliencies in aging is a critical springboard for the development of more holistic public health theories and interventions that support healthy aging among older sexual minority men. INTERNATIONAL REGISTERED REPORT RR1-10.2196/25750

Social support is linked to a myriad of positive health outcomes, yet little is understood about its potential role on frailty development among older men who have sex with men (MSM). We evaluated data from 929 MSM aged 40-81 years enrolled in the MACS Health Aging sub-study. Social support (Social Provisions Scale[SPS-24]; range 24-96) was high, though slightly lower among the HIV-positive versus HIV-negative men (median: 80 vs. 82, p=0.12). Each SD increase in social support associated with a 21% decrease in incident frailty (Fried phenotype), independent of age, race, and education (aIRR=0.79, IQR[0.65, 0.97]), though attenuated after adjustment for depressive symptoms. This protective association was observed to be strongest among HIV-positive MSM. High social support is a strength among older MSM, which associates with positive frailty outcomes. Assessing and strengthening social support systems may have potential as a psychosocial component of frailty interventions.

Self-perception of aging is an important predictor of quality of life. Therefore, we sought to examine self-perceptions of aging (age discrepancy and aging satisfaction) between HIV-positive and HIV-negative men in the Multicenter AIDS Cohort Study (MACS). We included 835 HIV-negative and 784 HIV-positive men aged 50 years and older who had completed a survey about age discrepancy and aging satisfaction from the "Attitude toward own aging" subscale of the Philadelphia Geriatric Center Morale scale. Multinomial generalized logit models were generated to assess self-perception of aging by HIV-status. Most of the participants self-identified as white, former smokers, and had completed high school. HIV-positive individuals reported higher prevalence of comorbidities than HIV-negative individuals. After adjusting for covariates, positive age discrepancy (older subjective age) was positively associated with being HIV-positive and having less than a high school education, depressive symptoms, diabetes, and medium and low aging satisfaction. Low aging satisfaction was associated with being a current and former smoker and having depressive symptoms, diabetes, and no age and positive age discrepancy. Being black had decreased odds of low aging satisfaction. These findings should inform health care professionals to promote positive views of aging in the assessment and management of HIV, depression, and diabetes.

Rationale Loneliness is associated with negative health outcomes, such as cardiovascular disease, cognitive impairment, dementia, physical functional decline, depression, and increased mortality risk, among HIV- positive and HIV-negative older men who have sex with men (MSM). Given these negative health outcomes, it is imperative to identify factors that minimize loneliness in these vulnerable groups. Objective We sought to examine whether social-environmental resiliencies—defined as an individual's level of support, social bonding, and psychological sense of community among gay men—buffer against symptoms of loneliness. Method We analyzed longitudinal data from 1,255 older MSM with and without HIV infection, all of whom were enrolled in the Multicenter AIDS Cohort Study (MACS). Using longitudinal latent class analysis (LLCA), we identified three underlying classes (Social Connectors, Non-community Connectors, and Social Isolates) in the social environment of the sample. We assessed the prevalence of loneliness by these latent classes. By lagging social environmental factors over time, we were able to examine the temporal relationships between latent classes and subsequent loneliness. Results Consistent with our hypothesis, multivariate associations revealed that compared to Social Connectors with high levels of social support and social bonding and a strong perceived sense of community among gay men, Social Isolates (Prevalence Ratio (PR): 1.42; 95% CI: 1.08–1.88; p = 0.0120) and Non-community Connectors (PR: 1.34; 95% CI: 1.03–1.75; p = 0.0322) were more likely to experience loneliness after adjustment for covariates and baseline loneliness. There were no differences by HIV status. Conclusions These longitudinal data allowed us to make causal inferences related to the social environmental resiliencies lowering the odds of loneliness among HIV-positive and HIV-negative older MSM. Developing individual- and community-level tailored interventions for these populations by leveraging social environmental resiliencies is key to reducing loneliness and promoting health.

This study describes the primary and secondary partnerships of aging gay men participating in the Understanding Patterns of Healthy Aging Among Men Who Have Sex with Men substudy of the Multicenter AIDS Cohort Study and examines differences in the prevalence of these relationship structures by HIV status while adjusting for age, education, and race/ethnicity. Relationships were compared within the following structural categories: “only a primary partnership”, “only a secondary partnership”, “both a primary and secondary relationship”, or “neither a primary nor secondary relationship”. There were 1,054 participants (51.9% HIV negative/48.1% HIV positive) included in the study. Participants had a median age of 62.0 years (interquartile range: 56.0–67.0) and most reported being non-Hispanic white (74.6%) and college educated (88.0%). Of the 1,004 participants with available partnership status data, 384 (38.2%) reported no primary or secondary partnerships, 108 (10.8%) reported secondary-only partnership, 385 (38.3%) reported primary-only partnership, and 127 (12.6%) reported both primary and secondary partnerships. Of participants who reported primary partnerships only, the prevalence rates (PRs) were lower among those 62 years and older, HIV positive, black non-Hispanic and Hispanics. Of participants who reported only having a secondary partnership, the PRs were higher among those 62 years and older and HIV positive. Of participants who did not report having either a primary or secondary partnership, the PRs were higher among those 62 years and older, HIV positive, and black non-Hispanic compared with their respective referent groups. There was no significant difference in PRs of having both primary and secondary partnerships by age category, HIV status, race/ethnicity, and education. This study aimed to fill a knowledge gap in the literature regarding both primary and secondary supportive partnerships among aging HIV-positive and HIV-negative gay men.

Men who have sex with men (MSM) report greater body dissatisfaction compared with heterosexual men, which increases with age. This may result from internalized gay community values regarding ideal physiques and youth. Using structural equation modeling, we examined these relationships among 1,118 MSM men age 40 and older from the Healthy Aging Study (M age=59.9 years/50.1% HIV+/69.8% non-Hispanic White). We hypothesized gay community attachment would be related to self-appraisals (body dissatisfaction/internalized ageism), and that this relationship would be mediated by developmental regulation strategies (physical activity/exercise intentions). The model fit the data well (RMSEA = .048, 90% CI 0.017-0.079). Contrary to our hypothesis, connection to the gay community was related to positive self-appraisals (-.40, p

Psychological sense of community (PSOC) in Black men who have sex with men (BMSM) may facilitate condom and pre-exposure prophylaxis (PrEP) use to prevent HIV transmission. Understanding BMSM’s PSOC contribution to HIV risk reduction may inform HIV prevention efforts for this population, that is disproportionately affected by HIV. Adjusted for sociodemographic characteristics and HIV status, we conducted logistic regressions to test the association between PSOC and condom use among aging BMSM (n=176). Multivariate analyses exhibited no association between PSOC and condom use (AOR= 0.994, 95% CI= 0.942, 1.049). HIV+ participants had higher condom use odds compared to HIV- participants (AOR= 4.031, 95% CI= 1.723, 9.426). A sub-analysis of HIV- participants (n=61), showed no associated between PSOC and PrEP use (AOR= 1.002, 95% CI= 0.904, 1.112). These results have implications for secondary HIV prevention and future research on alternative aspects of social support that may increase BMSM’s HIV risk reduction behaviors.

Neighborhoods are key socio-environmental contexts for marijuana use during emerging adulthood. This study examined the relationships between neighborhood context, traditional masculine norms (status, toughness, and anti-femininity), and marijuana use among 119 majority African American emerging adult men in a small urban community. Poisson regression models were used to determine the associations between neighborhood problems, social cohesion, and marijuana use. Moderator effects were examined to determine if masculinities modified these associations. Neighborhood problems and social cohesion were positively associated with marijuana use. Men who had a lower endorsement of some traditional masculine norms had greater marijuana use compared to men with a higher endorsement of these norms. These findings have implications for intervention strategies and policies.

BACKGROUND Over 90% of adults in the United States have at least one social media account, and lesbian, gay, and bisexual (LGB) persons are more socially active on social media than heterosexuals. Rates of depression among LGB persons are between 1.5- and 2-fold higher than those among their heterosexual counterparts. Social media allows users to connect, interact, and express ideas, emotions, feelings, and thoughts. Thus, social media use might represent both a protective and a risk factor for depression among LGB persons. Studying the nature of the relationship between social media use and depression among LGB individuals is a necessary step to inform public health interventions for this population. OBJECTIVE The objective of this systematic review was to synthesize and critique the evidence on social media use and depression among LGB populations. METHODS We conducted a literature search for quantitative and qualitative studies published between January 2003 and June 2017 using 3 electronic databases. Articles were included if they were peer-reviewed, were in English, assessed social media use either quantitatively or qualitatively, measured depression, and focused on LGB populations. A minimum of two authors independently extracted data from each study using an a priori developed abstraction form. We assessed appropriate reporting of studies using the Strengthening the Reporting of Observational Studies in Epidemiology and the Consolidated Criteria for Reporting Qualitative Research for quantitative and qualitative studies, respectively. RESULTS We included 11 articles in the review; 9 studies were quantitative and cross-sectional and 2 were qualitative. Appropriate reporting of results varied greatly. Across quantitative studies, we found heterogeneity in how social media use was defined and measured. Cyberbullying was the most studied social media experience and was associated with depression and suicidality. Qualitative studies found that while social media provides a space to disclose minority experiences and share ways to cope and get support, constant surveillance of one’s social media profile can become a stressor, potentially leading to depression. In most studies, sexual minority participants were identified inconsistently. CONCLUSIONS This review supports the need for research on the role of social media use on depression outcomes among LBG persons. Using social media may be both a protective and a risk factor for depression among LGB individuals. Support gained via social media may buffer the impact of geographic isolation and loneliness. Negative experiences such as cyberbullying and other patterns of use may be associated with depression. Future research would benefit from more consistent definitions of both social media use and study populations. Moreover, use of larger samples and accounting for patterns of use and individuals’ experiences on social media may help better understand the factors that impact LGB mental health disparities.

BackgroundOver 90% of adults in the United States have at least one social media account, and lesbian, gay, and bisexual (LGB) persons are more socially active on social media than heterosexuals. Rates of depression among LGB persons are between 1.5- and 2-fold higher than those among their heterosexual counterparts. Social media allows users to connect, interact, and express ideas, emotions, feelings, and thoughts. Thus, social media use might represent both a protective and a risk factor for depression among LGB persons. Studying the nature of the relationship between social media use and depression among LGB individuals is a necessary step to inform public health interventions for this population.ObjectiveThe objective of this systematic review was to synthesize and critique the evidence on social media use and depression among LGB populations.MethodsWe conducted a literature search for quantitative and qualitative studies published between January 2003 and June 2017 using 3 electronic databases. Articles were included if they were peer-reviewed, were in English, assessed social media use either quantitatively or qualitatively, measured depression, and focused on LGB populations. A minimum of two authors independently extracted data from each study using an a priori developed abstraction form. We assessed appropriate reporting of studies using the Strengthening the Reporting of Observational Studies in Epidemiology and the Consolidated Criteria for Reporting Qualitative Research for quantitative and qualitative studies, respectively.ResultsWe included 11 articles in the review; 9 studies were quantitative and cross-sectional and 2 were qualitative. Appropriate reporting of results varied greatly. Across quantitative studies, we found heterogeneity in how social media use was defined and measured. Cyberbullying was the most studied social media experience and was associated with depression and suicidality. Qualitative studies found that while social media provides a space to disclose minority experiences and share ways to cope and get support, constant surveillance of one’s social media profile can become a stressor, potentially leading to depression. In most studies, sexual minority participants were identified inconsistently.ConclusionsThis review supports the need for research on the role of social media use on depression outcomes among LBG persons. Using social media may be both a protective and a risk factor for depression among LGB individuals. Support gained via social media may buffer the impact of geographic isolation and loneliness. Negative experiences such as cyberbullying and other patterns of use may be associated with depression. Future research would benefit from more consistent definitions of both social media use and study populations. Moreover, use of larger samples and accounting for patterns of use and individuals’ experiences on social media may help better understand the factors that impact LGB mental health disparities.

Several studies have implicated the sexual networks of Black men who have sex with men (MSM) as facilitating disproportionally high rates of new HIV infections within this community. Although structural disparities place these networks at heightened risk for infection, HIV prevention science continues to describe networks as the cause for HIV disparities, rather than an effect of structures that pattern infection. We explore the historical relationship between public health and Black MSM, arguing that the current articulation of Black MSM networks is too often incomplete and counterproductive. Public health can offer a counternarrative that reconciles epidemiology with the social justice that informs our discipline, and that is required for an effective response to the epidemic among Black MSM.

Background : Minority engagement in HIV prevention research can improve the process and products of research. Using community-based participatory research (CBPR) to develop capacity-building tools can promote community awareness of HIV prevention, clinical research, and community roles in research. Objectives : We sought to describe a CBPR approach to curriculum development to increase HIV prevention research literacy among Blacks ages 18 to 30. Methods : Community members and researchers documented the iterative and participatory nature of curriculum development and lessons learned. Results/Lessons Learned : We used specific strategies to support and verify multi-stakeholder engagement, team building, capacity building, and shared decision making. Objective or formal assessments of baseline capacity, ongoing stakeholder engagement, and reinforcing the value of multiple perspectives can promote further equity in curriculum development between researchers and community members. Conclusions : The iterative process of shared discussion, development, and consensus building strengthened collaboration between stakeholder groups and produced a stronger, more culturally appropriate curriculum to promote HIV prevention research engagement among young Blacks.