122 results on '"Safren, Steven A."'
Search Results
2. Life Instability Associated with Lower ART Adherence and Other Poor HIV-Related Care Outcomes in Older Adults with HIV
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Weinstein, Elliott R., Harkness, Audrey, Ironson, Gail, Shrader, Cho-Hee, Duncan, Dustin T., and Safren, Steven A.
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- 2023
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3. Drug and alcohol use among people living with HIV in care in the United States by geographic region
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Crane, Heidi M, Nance, Robin M, Whitney, Bridget M, Ruderman, Stephanie, Tsui, Judith I, Chander, Geetanjali, McCaul, Mary E, Lau, Bryan, Mayer, Kenneth H, Batey, D Scott, Safren, Steven A, Moore, Richard D, Eron, Joseph J, Napravnik, Sonia, Mathews, W Chris, Fredericksen, Rob J, Hahn, Andrew W, Mugavero, Michael J, Lober, William B, Saag, Michael S, Kitahata, Mari M, and Delaney, Joseph AC
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Clinical and Health Psychology ,Health Sciences ,Public Health ,Human Society ,Psychology ,Sociology ,Prevention ,Substance Misuse ,Methamphetamine ,Brain Disorders ,Alcoholism ,Alcohol Use and Health ,HIV/AIDS ,Drug Abuse (NIDA only) ,Good Health and Well Being ,Alcohol Drinking ,Analgesics ,Opioid ,Crack Cocaine ,HIV Infections ,Humans ,Practice Patterns ,Physicians' ,United States ,Drug use ,alcohol use ,marijuana ,methamphetamine ,HIV ,Public Health and Health Services ,Public health ,Clinical and health psychology - Abstract
Substance use in the U.S. varies by geographic region. Opioid prescribing practices and marijuana, heroin, and methamphetamine availability are evolving differently across regions. We examined self-reported substance use among people living with HIV (PLWH) in care at seven sites from 2017-2019 to understand current regional substance use patterns. We calculated the percentage and standardized percentage of PLWH reporting current drug use and at-risk and binge alcohol use by U.S. Census Bureau geographic region and examined associations in adjusted logistic regression analyses. Among 7,686 PLWH, marijuana use was the most prevalent drug (30%), followed by methamphetamine/crystal (8%), cocaine/crack (7%), and illicit opioids (3%). One-third reported binge alcohol use (32%). Differences in percent of current use by region were seen for marijuana (24-41%) and methamphetamine/crystal (2-15%), with more use in the West and Northeast, and binge alcohol use (26-40%). In adjusted analyses, PLWH in the Midwest were significantly less likely to use methamphetamine/crystal (aOR: 0.13;0.06-0.25) or illicit opioids (aOR:0.16;0.05-0.53), and PLWH in the Northeast were more likely to use cocaine/crack (aOR:1.59;1.16-2.17), compared to PLWH in the West. Understanding differences in substance use patterns in the current era, as policies continue to evolve, will enable more targeted interventions in clinical settings among PLWH.
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- 2021
4. Factors associated with barriers to engagement in HIV-prevention care among sexual minority men
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Harkness, Audrey, Bainter, Sierra A, Mendez, Noelle A, Hernandez Altamirano, Daniel, O’Cleirigh, Conall, Mimiaga, Matthew J, Mayer, Kenneth H, and Safren, Steven A
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Public Health ,Health Sciences ,Behavioral and Social Science ,Prevention ,HIV/AIDS ,Pediatric ,Pediatric AIDS ,Sexual and Gender Minorities (SGM/LGBT*) ,Clinical Research ,Infectious Diseases ,Mental Health ,Infection ,Good Health and Well Being ,Female ,HIV Infections ,Homosexuality ,Male ,Humans ,Male ,Sexual Behavior ,Sexual and Gender Minorities ,Social Stigma ,Unsafe Sex ,HIV-prevention ,Sexual minority men ,Sexual orientation ,Disclosure ,Education ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Clinical Psychology ,Public health ,Social and personality psychology - Abstract
Engagement with HIV-prevention services varies among sexual minority men (SMM). 183 HIV-negative SMM completed a baseline assessment including sociodemographic, psychosocial, identity and stigma, and sexuality measures, as well as HIV-prevention behaviors: (1) date of most recent HIV test, (2) whether they discussed HIV or (3) sexual behavior with their provider, and (4) disclosure to provider about engaging in condomless anal sex (CAS). Factor analysis of these four items yielded an HIV-prevention engagement factor score. Stochastic search variable selection (SSVS) followed by multiple linear regression identified variables associated with HIV-prevention engagement. SSVS identified three variables for inclusion in a multiple linear regression model. Not disclosing sexual orientation to one's provider (p
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- 2021
5. Cabotegravir for HIV Prevention in Cisgender Men and Transgender Women
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Landovitz, Raphael J, Donnell, Deborah, Clement, Meredith E, Hanscom, Brett, Cottle, Leslie, Coelho, Lara, Cabello, Robinson, Chariyalertsak, Suwat, Dunne, Eileen F, Frank, Ian, Gallardo-Cartagena, Jorge A, Gaur, Aditya H, Gonzales, Pedro, Tran, Ha V, Hinojosa, Juan C, Kallas, Esper G, Kelley, Colleen F, Losso, Marcelo H, Madruga, J Valdez, Middelkoop, Keren, Phanuphak, Nittaya, Santos, Breno, Sued, Omar, Valencia Huamaní, Javier, Overton, Edgar T, Swaminathan, Shobha, Del Rio, Carlos, Gulick, Roy M, Richardson, Paul, Sullivan, Philip, Piwowar-Manning, Estelle, Marzinke, Mark, Hendrix, Craig, Li, Maoji, Wang, Zhe, Marrazzo, Jeanne, Daar, Eric, Asmelash, Aida, Brown, Todd T, Anderson, Peter, Eshleman, Susan H, Bryan, Marcus, Blanchette, Cheryl, Lucas, Jonathan, Psaros, Christina, Safren, Steven, Sugarman, Jeremy, Scott, Hyman, Eron, Joseph J, Fields, Sheldon D, Sista, Nirupama D, Gomez-Feliciano, Kailazarid, Jennings, Andrea, Kofron, Ryan M, Holtz, Timothy H, Shin, Katherine, Rooney, James F, Smith, Kimberly Y, Spreen, William, Margolis, David, Rinehart, Alex, Adeyeye, Adeola, Cohen, Myron S, McCauley, Marybeth, and Grinsztejn, Beatriz
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Prevention ,Patient Safety ,Clinical Research ,Sexual and Gender Minorities (SGM/LGBT*) ,HIV/AIDS ,Infectious Diseases ,Clinical Trials and Supportive Activities ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Infection ,Good Health and Well Being ,Administration ,Oral ,Adult ,Aged ,Anti-HIV Agents ,Delayed-Action Preparations ,Double-Blind Method ,Drug Administration Schedule ,Drug Resistance ,Female ,HIV Infections ,HIV Integrase Inhibitors ,Homosexuality ,Male ,Humans ,Injections ,Intramuscular ,Intention to Treat Analysis ,Male ,Medication Adherence ,Middle Aged ,Pre-Exposure Prophylaxis ,Pyridones ,Tenofovir ,Transgender Persons ,Young Adult ,HPTN 083 Study Team ,Medical and Health Sciences ,General & Internal Medicine - Abstract
BackgroundSafe and effective long-acting injectable agents for preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) infection are needed to increase the options for preventing HIV infection.MethodsWe conducted a randomized, double-blind, double-dummy, noninferiority trial to compare long-acting injectable cabotegravir (CAB-LA, an integrase strand-transfer inhibitor [INSTI]) at a dose of 600 mg, given intramuscularly every 8 weeks, with daily oral tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) for the prevention of HIV infection in at-risk cisgender men who have sex with men (MSM) and in at-risk transgender women who have sex with men. Participants were randomly assigned (1:1) to receive one of the two regimens and were followed for 153 weeks. HIV testing and safety evaluations were performed. The primary end point was incident HIV infection.ResultsThe intention-to-treat population included 4566 participants who underwent randomization; 570 (12.5%) identified as transgender women, and the median age was 26 years (interquartile range, 22 to 32). The trial was stopped early for efficacy on review of the results of the first preplanned interim end-point analysis. Among 1698 participants from the United States, 845 (49.8%) identified as Black. Incident HIV infection occurred in 52 participants: 13 in the cabotegravir group (incidence, 0.41 per 100 person-years) and 39 in the TDF-FTC group (incidence, 1.22 per 100 person-years) (hazard ratio, 0.34; 95% confidence interval, 0.18 to 0.62). The effect was consistent across prespecified subgroups. Injection-site reactions were reported in 81.4% of the participants in the cabotegravir group and in 31.3% of those in the TDF-FTC group. In the participants in whom HIV infection was diagnosed after exposure to CAB-LA, INSTI resistance and delays in the detection of HIV infection were noted. No safety concerns were identified.ConclusionsCAB-LA was superior to daily oral TDF-FTC in preventing HIV infection among MSM and transgender women. Strategies are needed to prevent INSTI resistance in cases of CAB-LA PrEP failure. (Funded by the National Institute of Allergy and Infectious Diseases and others; HPTN 083 ClinicalTrials.gov number, NCT02720094.).
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- 2021
6. Longitudinal Associations of Syndemic Conditions with Antiretroviral Therapy Adherence and HIV Viral Suppression Among HIV-Infected Patients in Primary Care
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Satyanarayana, Satyanand, Rogers, Brooke G, Bainter, Sierra A, Christopoulos, Katerina A, Fredericksen, Rob J, Mathews, William C, Moore, Richard D, Mugavero, Michael J, Napravnik, Sonia, Carrico, Adam W, Mimiaga, Matthew J, Mayer, Kenneth H, Crane, Heidi M, and Safren, Steven A
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Medical Microbiology ,Biomedical and Clinical Sciences ,Health Disparities ,Infectious Diseases ,Behavioral and Social Science ,Mental Health ,Sexually Transmitted Infections ,Substance Misuse ,Clinical Research ,Health Services ,Clinical Trials and Supportive Activities ,Prevention ,HIV/AIDS ,Management of diseases and conditions ,7.1 Individual care needs ,Infection ,Good Health and Well Being ,Anti-Retroviral Agents ,Continuity of Patient Care ,HIV Infections ,Humans ,Medication Adherence ,Syndemic ,Viral Load ,HIV ,syndemic conditions ,treatment as prevention ,patient-reported outcomes ,adherence ,Public Health and Health Services ,Virology ,Clinical sciences ,Public health - Abstract
Psychosocial syndemic conditions have received more attention regarding their deleterious effects on HIV acquisition risk than for their potential impact on HIV treatment and viral suppression. To examine syndemic conditions' impact on the HIV care continuum, we analyzed data collected from people living with HIV (N = 14,261) receiving care through The Centers for AIDS Research Network of Integrated Clinical Systems at seven sites from 2007 to 2017 who provided patient-reported outcomes ∼4-6 months apart. Syndemic condition count (depression, anxiety, substance use, and hazardous drinking), sexual risk group, and time in care were modeled to predict antiretroviral therapy (ART) adherence and viral suppression (HIV RNA
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- 2021
7. Strengthening resilience to reduce HIV risk in Indian MSM: a multicity, randomised, clinical efficacy trial
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Safren, Steven A, Thomas, Beena, Biello, Katie B, Mayer, Kenneth H, Rawat, Shruta, Dange, Alpana, Bedoya, C Andres, Menon, Sunil, Anand, Vivek, Balu, Vinoth, O’Cleirigh, Conall, Klasko-Foster, Lynne, Baruah, Dicky, Swaminathan, Soumya, and Mimiaga, Matthew J
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Public Health ,Health Sciences ,HIV/AIDS ,Sexually Transmitted Infections ,Mental Health ,Prevention ,Clinical Trials and Supportive Activities ,Mind and Body ,Clinical Research ,Sexual and Gender Minorities (SGM/LGBT*) ,Infectious Diseases ,Behavioral and Social Science ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Prevention of disease and conditions ,and promotion of well-being ,Infection ,Mental health ,Good Health and Well Being ,Adult ,Counseling ,Follow-Up Studies ,HIV Infections ,HIV Testing ,Humans ,India ,Male ,Psychiatric Rehabilitation ,Resilience ,Psychological ,Risk Reduction Behavior ,Sexual Behavior ,Sexual and Gender Minorities ,Social Stigma ,Treatment Outcome ,Unsafe Sex ,Young Adult ,Microbiology ,Public Health and Health Services ,Epidemiology ,Health services and systems ,Public health - Abstract
BackgroundMen who have sex with men (MSM) in India are extremely marginalised and stigmatised, and therefore experience immense psychosocial stress. As current HIV prevention interventions in India do not address mental health or resilience to these stressors, we aimed to evaluate a resilience-based psychosocial intervention in the context of HIV and sexually transmitted infection (STI) prevention.MethodsWe did a multicity, randomised, clinical efficacy trial in Chennai (governmental tuberculosis research institute) and Mumbai (non-governmental organisation for MSM), India. Inclusion criteria were MSM, aged 18 years or older, who were at risk of HIV acquisition or transmission, defined as having any of the following in the 4 months before screening: anal sex with four or more male partners (protected or unprotected), diagnosis of an STI, history of transactional sex activity, or condomless anal sex with a man who was of unknown HIV status or serodiscordant. Participants were required to speak English, Tamil (in Chennai), or Hindi (in Mumbai) fluently. Eligible individuals were randomly assigned (1:1) to either a resilience-based psychosocial HIV prevention intervention, consisting of group (four sessions) and individual (six sessions) counselling alongside HIV and STI voluntary counselling and testing, or a standard-of-care control comprising voluntary counselling and testing alone. The primary outcomes were number of condomless anal sex acts with male partners during the past month (at baseline and 4 months, 8 months, and 12 months after randomisation), and incident bacterial STIs (at 12 months after randomisation). Resilience-related mediators included self-esteem, self-acceptance, and depression. Recruitment is now closed. This trial is registered with ClinicalTrials.gov, NCT02556294.FindingsBetween Sept 4, 2015, and June 28, 2018, we enrolled 608 participants; 305 (50%) were assigned to the psychosocial intervention condition and 303 (50%) were assigned to the control condition. 510 (84%) of 608 men completed an assessment at 4 months after randomisation, 483 (79%) at 8 months, and 515 (85%) at 12 months. 512 (99%) of 515 men had STI data from the 12-month assessment. The intervention condition had a 56% larger reduction in condomless anal sex acts (95% CI 35-71; p
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- 2021
8. Estimating HIV transmissions in a large U.S. clinic‐based sample: effects of time and syndemic conditions
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Satyanarayana, Satyanand, Safren, Steven A, Rogers, Brooke G, Bainter, Sierra A, Christopoulos, Katerina A, Fredericksen, Rob J, Mathews, William C, Moore, Richard D, Mugavero, Michael J, Napravnik, Sonia, Carrico, Adam W, Mimiaga, Matthew J, Mayer, Kenneth H, and Crane, Heidi M
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Biomedical and Clinical Sciences ,Clinical Sciences ,Substance Misuse ,Behavioral and Social Science ,Sexual and Gender Minorities (SGM/LGBT*) ,Infectious Diseases ,Clinical Research ,Health Disparities ,HIV/AIDS ,Sexually Transmitted Infections ,Women's Health ,Prevention ,Mental Health ,Infection ,Good Health and Well Being ,Antiretroviral Therapy ,Highly Active ,Cohort Studies ,Continuity of Patient Care ,Female ,HIV Infections ,Humans ,Male ,Patient Reported Outcome Measures ,Sexual Behavior ,Syndemic ,Time Factors ,Treatment Outcome ,United States ,Viral Load ,Cohort studies ,HIV prevention ,HIV care continuum ,viral suppression ,treatment ,North America ,Public Health and Health Services ,Other Medical and Health Sciences ,Clinical sciences ,Epidemiology ,Public health - Abstract
IntroductionLittle is known about onward HIV transmissions from people living with HIV (PLWH) in care. Antiretroviral therapy (ART) has increased in potency, and treatment as prevention (TasP) is an important component of ending the epidemic. Syndemic theory has informed modelling of HIV risk but has yet to inform modelling of HIV transmissions.MethodsData were from 61,198 primary HIV care visits for 14,261 PLWH receiving care through the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) at seven United States (U.S.) sites from 2007 to 2017. Patient-reported outcomes and measures (PROs) of syndemic conditions - depressive symptoms, anxiety symptoms, drug use (opiates, amphetamines, crack/cocaine) and alcohol use - were collected approximately four to six months apart along with sexual behaviours (mean = 4.3 observations). Counts of syndemic conditions, HIV sexual risk group and time in care were modelled to predict estimated HIV transmissions resulting from sexual behaviour and viral suppression status (HIV RNA
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- 2021
9. The persistent and evolving HIV epidemic in American men who have sex with men
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Mayer, Kenneth H, Nelson, LaRon, Hightow-Weidman, Lisa, Mimiaga, Matthew J, Mena, Leandro, Reisner, Sari, Daskalakis, Demetre, Safren, Steven A, Beyrer, Chris, and Sullivan, Patrick S
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Clinical Sciences ,Clinical Research ,Prevention ,Sexual and Gender Minorities (SGM/LGBT*) ,Behavioral and Social Science ,Infectious Diseases ,HIV/AIDS ,Prevention of disease and conditions ,and promotion of well-being ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Aetiology ,2.3 Psychological ,social and economic factors ,Infection ,Good Health and Well Being ,Acquired Immunodeficiency Syndrome ,Adolescent ,Adult ,Anti-Retroviral Agents ,COVID-19 ,Comorbidity ,HIV Infections ,Homosexuality ,Male ,Humans ,Incidence ,Male ,Middle Aged ,Minority Groups ,Pre-Exposure Prophylaxis ,Risk Factors ,SARS-CoV-2 ,Sexual Behavior ,Sexual Partners ,Sexual and Gender Minorities ,Transgender Persons ,United States ,Young Adult ,Medical and Health Sciences ,General & Internal Medicine ,Biomedical and clinical sciences ,Health sciences - Abstract
Men who have sex with men (MSM) in the USA were the first population to be identified with AIDS and continue to be at very high risk of HIV acquisition. We did a systematic literature search to identify the factors that explain the reasons for the ongoing epidemic in this population, using a social-ecological perspective. Common features of the HIV epidemic in American MSM include role versatility and biological, individual, and social and structural factors. The high-prevalence networks of some racial and ethnic minority men are further concentrated because of assortative mixing, adverse life experiences (including high rates of incarceration), and avoidant behaviour because of negative interactions with the health-care system. Young MSM have additional risks for HIV because their impulse control is less developed and they are less familiar with serostatus and other risk mitigation discussions. They might benefit from prevention efforts that use digital technologies, which they often use to meet partners and obtain health-related information. Older MSM remain at risk of HIV and are the largest population of US residents with chronic HIV, requiring culturally responsive programmes that address longer-term comorbidities. Transgender MSM are an understudied population, but emerging data suggest that some are at great risk of HIV and require specifically tailored information on HIV prevention. In the current era of pre-exposure prophylaxis and the undetectable equals untransmittable campaign, training of health-care providers to create culturally competent programmes for all MSM is crucial, since the use of antiretrovirals is foundational to optimising HIV care and prevention. Effective control of the HIV epidemic among all American MSM will require scaling up programmes that address their common vulnerabilities, but are sufficiently nuanced to address the specific sociocultural, structural, and behavioural issues of diverse subgroups.
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- 2021
10. Substance Use, Mental Health Problems, and Physical and Sexual Violence Additively Increase HIV Risk Between Male Sex Workers and Their Male Clients in Northeastern United States.
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Mimiaga, Matthew J, Hughto, Jaclyn MW, Klasko-Foster, Lynne, Jin, Harry, Mayer, Kenneth H, Safren, Steven A, and Biello, Katie B
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Behavioral and Social Science ,Clinical Research ,Violence Research ,HIV/AIDS ,Drug Abuse (NIDA only) ,Substance Misuse ,Infectious Diseases ,Mental Health ,Prevention ,2.3 Psychological ,social and economic factors ,Aetiology ,Mental health ,Good Health and Well Being ,Peace ,Justice and Strong Institutions ,Adult ,Cross-Sectional Studies ,Ethnicity ,HIV Infections ,Homosexuality ,Male ,Humans ,Male ,Middle Aged ,Minority Groups ,New England ,Odds Ratio ,Prevalence ,Prospective Studies ,Risk-Taking ,Sex Offenses ,Sex Workers ,Sexual Behavior ,Substance-Related Disorders ,Syndemic ,Unsafe Sex ,Young Adult ,syndemic ,male sex worker ,HIV sexual risk behavior ,mental health ,substance use ,physical abuse ,sexual abuse ,childhood sexual abuse ,Clinical Sciences ,Public Health and Health Services ,Virology - Abstract
BackgroundMale sex workers (MSW) are disproportionately affected by HIV/AIDS, with an estimated HIV prevalence in the United States of 19.3%. Existing research suggests that MSW are also at risk of adverse psychosocial problems. Cross-sectional studies of MSW have suggested that co-occurring epidemics or a "syndemic" of psychosocial problems may increase vulnerability to HIV acquisition/transmission by elevated sexual risk. To the best of our knowledge, there are no published studies examining this relationship longitudinally among MSW. This study examined how a syndemic of 6 psychosocial problems result in additive risk for condomless anal sex (CAS) with male clients among a multicity, longitudinal cohort of MSW.SettingCommunity-based organization and health center in 2 Northeastern US cities.MethodsBetween 2015 and 2017, 100 MSW from Boston, MA and Providence, RI completed behavioral/psychosocial surveys at baseline, 6 months, and 12months. Generalized estimating equation modeling was used to examine the prospective relationship of additive psychosocial problems and subsequent CAS with male clients, adjusting for age, site, race/ethnicity, MSW-type, and HIV serostatus.ResultsMean age = 34.7 (SD = 11.8); 62% racial/ethnic minority; and 20% HIV+. The prevalence of 6 psychosocial syndemic problems was substantial at baseline and remained high at each time point (all within the past 6 months): 74% problematic depressive symptoms, 27% polydrug use (3+ drugs, not including stimulants), 57% stimulant (methamphetamine/cocaine/crack) use, 44% hazardous drinking, 15% experienced client-specific physical/sexual violence, and 57% childhood sexual abuse. Looking at the number of psychosocial problems experienced, 7% had zero, 27% had 1, 24% had 2, 27% had 3, and 15% had 4 or more. We identified a statistically significant positive "dose-response" relationship between the number of psychosocial problems and CAS with male clients over time, with the greatest odds of engaging in CAS with a male client over follow-up among those with 4 or more psychosocial problems (adjusted odds ratio = 5.18, 95% CI: 1.61 to 16.62).ConclusionsInternet escorts and street-based MSW are likely to experience psychosocial problems and engaging in HIV sexual risk with male clients. The accumulation of psychosocial problems additively predicted CAS with male clients in a prospective cohort of MSW. The specification of psychosocial problems presents distinct treatment targets for HIV prevention among MSW in the United States.
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- 2021
11. Geographic and behavioral differences associated with sexually transmitted infection prevalence among Indian men who have sex with men in Chennai and Mumbai.
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Safren, Steven A, Devaleenal, Bella, Biello, Katie B, Rawat, Shruta, Thomas, Beena E, Regenauer, Kristen S, Balu, Vinoth, Bedoya, C Andres, Dange, Alpana, Menon, Sunil, O'Cleirigh, Conall, Baruah, Dicky, Anand, Vivek, Hanna, Luke E, Karunaianantham, Ramesh, Thorat, Rakesh, Swaminathan, Soumya, Mimiaga, Matthew J, and Mayer, Kenneth H
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Humans ,Chlamydia Infections ,Gonorrhea ,Sexually Transmitted Diseases ,HIV Infections ,Prevalence ,Sexual Behavior ,Homosexuality ,Male ,Adult ,India ,Male ,Gay men ,chlamydia infection ,gonorrhea ,sexual behavior ,syphilis ,Sexually Transmitted Infections ,Behavioral and Social Science ,Clinical Research ,HIV/AIDS ,Prevention ,Infectious Diseases ,Sexual and Gender Minorities (SGM/LGBT*) ,Infection ,Good Health and Well Being ,Clinical Sciences ,Medical Microbiology ,Public Health and Health Services ,Public Health - Abstract
India has one of the largest numbers of men who have sex with men (MSM) globally; however, geographic data on sexually transmitted infection (STI) prevalence and associations with sexual behavior are limited. Six-hundred and eight MSM in Chennai and Mumbai underwent screening for a behavioral trial and were assessed for bacterial STIs (syphilis, chlamydia, gonorrhea), HIV, and past-month self-reported condomless anal sex (CAS). Mumbai (37.8%) had a greater prevalence of any STI than Chennai (27.6%) (prevalence ratio [PR] = 1.37, 95% CI: 1.09, 1.73). This pattern also emerged for gonorrhea and chlamydia separately but not syphilis. Conversely, Mumbai MSM reported lower rates of CAS (mean = 2.2) compared to Chennai MSM (mean = 14.0) (mean difference = -11.8, 95% CI: -14.6, -9.1). The interaction of city by CAS on any STI prevalence (PR = 2.09, 95% CI: 1.45, 3.01, p
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- 2021
12. Feasibility of Short-Term PrEP Uptake for Men Who Have Sex With Men With Episodic Periods of Increased HIV Risk.
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Egan, James E, Ho, Ken, Stall, Ron, Drucker, Moe T, Tappin, Ryan, Hendrix, Craig W, Marzinke, Mark A, Safren, Steven A, Mimiaga, Matthew J, Psaros, Christina, Elsesser, Steven, and Mayer, Kenneth H
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Humans ,HIV-1 ,HIV Infections ,Anti-HIV Agents ,Drug Administration Schedule ,Risk Factors ,Feasibility Studies ,Sexual Behavior ,Safe Sex ,Homosexuality ,Male ,Adult ,Male ,Medication Adherence ,Pre-Exposure Prophylaxis ,Clinical Trials and Supportive Activities ,Behavioral and Social Science ,HIV/AIDS ,Sexual and Gender Minorities (SGM/LGBT*) ,Prevention ,Infectious Diseases ,Clinical Research ,Good Health and Well Being ,Clinical Sciences ,Public Health and Health Services ,Virology - Abstract
BackgroundPre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate is efficacious in reducing HIV acquisition. For some gay, bisexual, and other men who have sex with men (MSM), daily ongoing PrEP may be unsuitable for use as a long-term prevention strategy because of episodic risk, cost issues, or concerns about the biological consequences of medication.SettingThis study evaluated the feasibility of short-term, fixed-interval episodic PrEP (Epi-PrEP) for use among vacationing MSM. We describe the feasibility of implementing a clinic-based Epi-PrEP pilot program for 48 MSM who reported occasional condomless sex and anticipated a defined high-risk time.MethodsThis was a nonrandomized naturalistic study of an observational clinical intervention. The primary outcome assessed was adherence, as measured by self-report and plasma tenofovir levels.ResultsOf 54 MSM who enrolled in the study, 48 completed the 3-month visit. The majority (93.7%) had tenofovir concentrations consistent with daily use on returning from vacation. Almost 3/4 reported condomless sex during vacation, and about 1/3 reported recreational drug use. During the 3-month follow-up, 1 participant had become HIV-infected because of a lapse in continued access to the PrEP after study. Although adverse events were common, none were serious. More than 70% of participants indicated an interest in daily ongoing PrEP use.ConclusionsEpi-PrEP was well tolerated by at risk MSM in this study, with high levels of medication adherence. Many participants felt the experience of initiating PrEP while on vacation could be a means for transition to long-term PrEP use.
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- 2020
13. Syndemics and the PrEP Cascade: Results from a Sample of Young Latino Men Who Have Sex with Men
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Blashill, Aaron J, Brady, John P, Rooney, Benjamin M, Rodriguez-Diaz, Carlos E, Horvath, Keith J, Blumenthal, Jill, Morris, Sheldon, Moore, David J, and Safren, Steven A
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Clinical and Health Psychology ,Social and Personality Psychology ,Human Society ,Psychology ,Gender Studies ,Sexual and Gender Minorities (SGM/LGBT*) ,Pediatric ,HIV/AIDS ,Pediatric AIDS ,Infectious Diseases ,Clinical Research ,Prevention ,Behavioral and Social Science ,Mental Health ,Infection ,Adult ,HIV Infections ,Hispanic or Latino ,Homosexuality ,Male ,Humans ,Incidence ,Male ,Pre-Exposure Prophylaxis ,Surveys and Questionnaires ,Syndemic ,Young Adult ,PrEP ,Latino ,MSM ,Syndemics ,HIV prevention ,Sexual orientation ,Public Health and Health Services ,Other Studies in Human Society ,Clinical Psychology ,Gender studies ,Clinical and health psychology ,Social and personality psychology - Abstract
Young Latino men who have sex with men (MSM) are a highly vulnerable population for HIV infection. Pre-exposure prophylaxis (PrEP) is a novel biomedical HIV prevention tool that may aid in reducing the disparity in HIV incidence among Latino MSM. However, PrEP use is disproportionally low among Latino MSM and, therefore, identifying barriers along the PrEP continuum of care (the "PrEP cascade") would provide insight into how to best deploy PrEP interventions. Syndemics theory is a prominent framework employed in HIV prevention; however, to date, no known studies have applied this theory to PrEP. Thus, the aim of the current study was to explore the association between syndemics and the PrEP cascade, including the degree to which psychosocial and structural syndemic constructs are related to the PrEP cascade. Participants were 151 young Latino MSM (M age = 24 years; SD = 3) residing in San Diego, California, who completed a battery of online self-report measures. Results indicated high levels of syndemic indicators and varying levels of engagement across the PrEP cascade. As syndemic indicators increased, the odds of engagement across the PrEP cascade were significantly lowered. Psychosocial and structural syndemic factors accounted for unique variance in the PrEP cascade. Results highlight the need for combination interventions that address both psychosocial and structural barriers to PrEP use and persistence among young Latino MSM.
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- 2020
14. The Longitudinal Effects of Non-injection Substance Use on Sustained HIV Viral Load Undetectability Among MSM and Heterosexual Men in Brazil and Thailand: The Role of ART Adherence and Depressive Symptoms (HPTN 063)
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Tsuyuki, Kiyomi, Shoptaw, Steven J, Ransome, Yusuf, Chau, Gordon, Rodriguez-Diaz, Carlos E, Friedman, Ruth K, Srithanaviboonchai, Kriengkrai, Li, Sue, Mimiaga, Matthew J, Mayer, Kenneth H, and Safren, Steven A
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Public Health ,Health Sciences ,Behavioral and Social Science ,Depression ,Mental Health ,Clinical Research ,Drug Abuse (NIDA only) ,Substance Misuse ,HIV/AIDS ,Prevention ,Infectious Diseases ,Infection ,Mental health ,Good Health and Well Being ,Adult ,Anti-HIV Agents ,Brazil ,Drug Users ,Female ,HIV Infections ,HIV-1 ,Heterosexuality ,Homosexuality ,Male ,Humans ,Longitudinal Studies ,Male ,Medication Adherence ,Middle Aged ,Substance-Related Disorders ,Thailand ,Viral Load ,Young Adult ,Zambia ,Substance use ,HIV ,Adherence ,Undetectable viral load ,Public Health and Health Services ,Social Work ,Public health - Abstract
The effect of non-injection substance use on HIV viral load (VL) is understudied in international settings. Data are from HPTN063, a longitudinal observational study of HIV-infected individuals in Brazil, Thailand, and Zambia, with focus on men with VL data (Brazil = 146; Thailand = 159). Generalized linear mixed models (GLMM) assessed whether non-injection substance use (stimulants, cannabis, alcohol, polysubstance) was associated with VL undetectability. ART adherence and depressive symptoms were examined as mediators of the association. In Thailand, substance use was not significantly associated with VL undetectability or ART adherence, but alcohol misuse among MSM was associated with increased odds of depression (AOR = 2.75; 95% CI 1.20, 6.32, p = 0.02). In Brazil, alcohol misuse by MSM was associated with decreased odds of undetectable VL (AOR = 0.34; 95% CI 0.13, 0.92, p = 0.03). Polysubstance use by heterosexual men in Brazil was associated with decreased odds of ART adherence (AOR = 0.25; 95% CI 0.08, 0.78, p = 0.02). VL suppression appears attainable among non-injection substance users. Substance use interventions among HIV-positive men should address depression, adherence, and VL undetectability.
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- 2019
15. A randomized clinical efficacy trial of a psychosocial intervention to strengthen self-acceptance and reduce HIV risk for MSM in India: study protocol
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Mimiaga, Matthew J, Thomas, Beena, Mayer, Kenneth H, Regenauer, Kristen S, Dange, Alpana, Andres Bedoya, C, Rawat, Shruta, Balu, Vinoth, O’Cleirigh, Conall, Biello, Katie B, Anand, Vivek, Swaminathan, Soumya, and Safren, Steven A
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Public Health ,Health Sciences ,Behavioral and Social Science ,Mind and Body ,Pediatric ,Sexually Transmitted Infections ,Mental Health ,Prevention ,Pediatric AIDS ,Sexual and Gender Minorities (SGM/LGBT*) ,Clinical Research ,Infectious Diseases ,Clinical Trials and Supportive Activities ,HIV/AIDS ,Prevention of disease and conditions ,and promotion of well-being ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Infection ,Good Health and Well Being ,Adolescent ,Adult ,Condoms ,Counseling ,Disease Transmission ,Infectious ,HIV Infections ,Homosexuality ,Male ,Humans ,Incidence ,India ,Male ,Mass Screening ,Research Design ,Risk Reduction Behavior ,Sexual Behavior ,Sexual and Gender Minorities ,Sexually Transmitted Diseases ,Standard of Care ,Unsafe Sex ,HIV prevention ,MSM ,Psychosocial intervention ,Randomized controlled trial ,STI prevention ,Self-acceptance ,Public Health and Health Services ,Epidemiology ,Health services and systems ,Public health - Abstract
BackgroundMen who have sex with men (MSM) in India are a key group at risk for HIV acquisition and transmission. They are also an extremely marginalized and stigmatized population, facing immense psychosocial stressors including, but not limited to, stigma, homophobia, discrimination, criminalization, low self-esteem, low self-acceptance, distress, and, as a result, high rates of mental health problems. Although these multi-level psychosocial problems may put MSM at high risk for HIV acquisition and transmission, currently HIV prevention interventions in India do not address them. This paper describes the design of a psychosocial intervention to reduce HIV risk for MSM in India.MethodsFunded by the National Institute of Mental Health, this study is a two-arm randomized clinical efficacy trial of a self-acceptance based psychosocial HIV prevention intervention, informed by the minority stress model and syndemic theory, that was developed with extensive community-based formative work and input from the Indian MSM community and key informants who are knowledgeable about the experiences faced by MSM in India. Participants are MSM in Chennai and Mumbai who endorsed recent sexual behaviors placing them at high risk for HIV/sexually transmitted infection (STI) acquisition and transmission. Enrolled participants are equally randomized to either 1) the experimental condition, which consists of four group and six individual counseling sessions and includes standard of care HIV/STI testing and counseling, or 2) the standard of care condition, which includes HIV/STI testing and counseling alone. The primary outcomes are changes in the frequency of condomless anal sex acts and STI incidence (syphilis seropositivity and urethral, rectal, and pharyngeal gonorrhea and chlamydia infection. Major study assessment visits occur at baseline, 4-, 8-, and 12-months.DiscussionHIV prevention interventions that address the psychosocial stressors faced by MSM in India are needed; this study will examine the efficacy of such an intervention. If the intervention is successful, it may be able to reduce the national HIV/AIDS burden in India while empowering a marginalized and highly stigmatized group.Trial registrationClinicalTrials.gov Identifier: NCT02556294 , registered 22 September 2015.
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- 2018
16. A randomized controlled efficacy trial of behavioral activation for concurrent stimulant use and sexual risk for HIV acquisition among MSM: project IMPACT study protocol
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Mimiaga, Matthew J, Pantalone, David W, Biello, Katie B, Glynn, Tiffany Rose, Santostefano, Christopher M, Olson, Jennifer, Pardee, Dana J, Hughto, Jaclyn MW, Garcia Valles, Josibel, Carrico, Adam W, Mayer, Kenneth H, and Safren, Steven A
- Subjects
Public Health ,Health Sciences ,Pediatric AIDS ,Substance Misuse ,Drug Abuse (NIDA only) ,Behavioral and Social Science ,HIV/AIDS ,Clinical Trials and Supportive Activities ,Mental Health ,Prevention ,Pediatric ,Infectious Diseases ,Clinical Research ,Sexual and Gender Minorities (SGM/LGBT*) ,Mind and Body ,Prevention of disease and conditions ,and promotion of well-being ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Infection ,Good Health and Well Being ,Adult ,Behavior Therapy ,Boston ,Central Nervous System Stimulants ,Florida ,HIV ,HIV Infections ,Homosexuality ,Male ,Humans ,Male ,Pre-Exposure Prophylaxis ,Randomized Controlled Trials as Topic ,Risk Reduction Behavior ,Risk-Taking ,Safe Sex ,Sex Counseling ,Sexual Behavior ,Sexual Partners ,Sexual and Gender Minorities ,Substance-Related Disorders ,Treatment Outcome ,Behavioral activation ,Men who have sex with men ,Sexual risk ,Stimulant use ,Public Health and Health Services ,Epidemiology ,Health services and systems ,Public health - Abstract
BackgroundIn the United States, problematic stimulant use is a prevalent and difficult to treat problem among men who have sex with men (MSM), as well as a major driver of HIV transmission through the large number of sexual partners and concomitant condomless anal sex (CAS). Evidence-based behavioral studies that address problematic stimulant use in MSM at risk for HIV infection are also lacking. In this paper, we describe the design of a behavioral intervention trial to reduce sexual risk behavior and stimulant use in HIV-uninfected MSM.MethodsThis study, funded by the National Institute on Drug Abuse (NIDA), is a randomized controlled trial (RCT) testing an integrated HIV risk reduction and behavioral activation counseling intervention (IMPACT) for HIV-uninfected, stimulant using MSM in Boston, MA, and Miami, FL. Participants are randomized (2:2:1) to either (1) the IMPACT intervention; (2) a relaxation condition, an active therapy time- and intensity-matched control; or (3) a standard of care risk reduction counseling comparison. At enrollment, all participants receive an HIV test and pre- and post-test counseling. The primary outcome is the difference in the rate of change in the number of self-reported condomless anal sex acts without the protection of consistent Pre-Exposure Prophylaxis (PrEP) use, as well as reductions in stimulant use during the prior 4-months. Major assessments are conducted at baseline, 4-, 8-, and 12-month follow-up visits.DiscussionEffective and sustainable behavioral interventions are sorely needed to reduce HIV acquisition in stimulant using MSM at risk for HIV infection. In this study, we will evaluate the evidence of efficacy of the IMPACT intervention to reduce HIV acquisition in HIV-uninfected, stimulant-using MSM. If found effective, the intervention tested here holds promise for being readily integrated into real-world clinical settings.Trial registrationClinicalTrials.gov number NCT03175159 , registered June 5, 2017.
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- 2018
17. Act Healthy: A Randomized Clinical Trial Evaluating a Behavioral Activation Intervention to Address Substance Use and Medication Adherence Among Low-Income, Black/African American Individuals Living with HIV/AIDS
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Magidson, Jessica F., Belus, Jennifer M., Seitz-Brown, C. J., Tralka, Hannah, Safren, Steven A., and Daughters, Stacey B.
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- 2022
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18. HIV Viral Suppression Trends Over Time Among HIV-Infected Patients Receiving Care in the United States, 1997 to 2015: A Cohort Study.
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Nance, Robin M, Delaney, JA Chris, Simoni, Jane M, Wilson, Ira B, Mayer, Kenneth H, Whitney, Bridget M, Aunon, Frances M, Safren, Steven A, Mugavero, Michael J, Mathews, W Christopher, Christopoulos, Katerina A, Eron, Joseph J, Napravnik, Sonia, Moore, Richard D, Rodriguez, Benigno, Lau, Bryan, Fredericksen, Rob J, Saag, Michael S, Kitahata, Mari M, and Crane, Heidi M
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Clinical Research ,HIV/AIDS ,Prevention ,Infectious Diseases ,Behavioral and Social Science ,Infection ,Good Health and Well Being ,Adult ,Age Factors ,Anti-HIV Agents ,Depression ,Female ,HIV Infections ,HIV Integrase Inhibitors ,Humans ,Longitudinal Studies ,Male ,Medication Adherence ,Middle Aged ,Race Factors ,Substance-Related Disorders ,United States ,Viral Load ,Clinical Sciences ,Public Health and Health Services - Abstract
BackgroundBecause HIV viral suppression is essential for optimal outcomes and prevention efforts, understanding trends and predictors is imperative to inform public health policy.ObjectiveTo evaluate viral suppression trends in people living with HIV (PLWH), including the relationship of associated factors, such as demographic characteristics and integrase strand transfer inhibitor (ISTI) use.DesignLongitudinal observational cohort study.Setting8 HIV clinics across the United States.ParticipantsPLWH receiving clinical care.MeasurementsTo understand trends in viral suppression (≤400 copies/mL), annual viral suppression rates from 1997 to 2015 were determined. Analyses were repeated with tests limited to 1 random test per person per year and using inverse probability of censoring weights to address loss to follow-up. Joint longitudinal and survival models and linear mixed models of PLWH receiving antiretroviral therapy (ART) were used to examine associations between viral suppression or continuous viral load (VL) levels and demographic factors, substance use, adherence, and ISTI use.ResultsViral suppression increased from 32% in 1997 to 86% in 2015 on the basis of all tests among 31 930 PLWH. In adjusted analyses, being older (odds ratio [OR], 0.76 per decade [95% CI, 0.74 to 0.78]) and using an ISTI-based regimen (OR, 0.54 [CI, 0.51 to 0.57]) were associated with lower odds of having a detectable VL, and black race was associated with higher odds (OR, 1.68 [CI, 1.57 to 1.80]) (P < 0.001 for each). Similar patterns were seen with continuous VL levels; when analyses were limited to 2010 to 2015; and with adjustment for adherence, substance use, or depression.LimitationResults are limited to PLWH receiving clinical care.ConclusionHIV viral suppression rates have improved dramatically across the United States, which is likely partially attributable to improved ART, including ISTI-based regimens. However, disparities among younger and black PLWH merit attention.Primary funding sourceNational Institutes of Health.
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- 2018
19. Disparities in Depressive Symptoms and Antidepressant Treatment by Gender and Race/Ethnicity among People Living with HIV in the United States
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Bengtson, Angela M, Pence, Brian W, Crane, Heidi M, Christopoulos, Katerina, Fredericksen, Rob J, Gaynes, Bradley N, Heine, Amy, Mathews, W Christopher, Moore, Richard, Napravnik, Sonia, Safren, Steven, and Mugavero, Michael J
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Biomedical and Clinical Sciences ,Clinical Sciences ,Health Sciences ,Clinical Research ,Depression ,Brain Disorders ,Mental Health ,HIV/AIDS ,Behavioral and Social Science ,Good Health and Well Being ,Adult ,Black or African American ,Antidepressive Agents ,Depressive Disorder ,Ethnicity ,Female ,HIV Infections ,HIV-1 ,Healthcare Disparities ,Humans ,Male ,Middle Aged ,Prevalence ,Racial Groups ,United States ,White People ,General Science & Technology - Abstract
ObjectiveTo describe disparities along the depression treatment cascade, from indication for antidepressant treatment to effective treatment, in HIV-infected individuals by gender and race/ethnicity.MethodsThe Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) cohort includes 31,000 HIV-infected adults in routine clinical care at 8 sites. Individuals were included in the analysis if they had a depressive symptoms measure within one month of establishing HIV care at a CNICS site. Depressive symptoms were measured using the validated Patient Health Questionnaire-9 (PHQ-9). Indication for antidepressant treatment was defined as PHQ-9 ≥ 10 or a current antidepressant prescription. Antidepressant treatment was defined as a current antidepressant prescription. Evidence-based antidepressant treatment was considered treatment changes based on a person's most recent PHQ-9, in accordance with clinical guidelines. We calculated the cumulative probability of moving through the depression treatment cascade within 24 months of entering CNICS HIV care. We used multivariable Cox proportional hazards models to estimate associations between gender, race/ethnicity, and a range of depression outcomes.ResultsIn our cohort of HIV-infected adults in routine care, 47% had an indication for antidepressant treatment. Significant drop-offs along the depression treatment cascade were seen for the entire study sample. However, important disparities existed. Women were more likely to have an indication for antidepressant treatment (HR 1.54; 95% CI 1.34, 1.78), receive antidepressant treatment (HR 2.03; 95% CI 1.53, 2.69) and receive evidence-based antidepressant treatment (HR 1.67; 95% CI 1.03, 2.74), even after accounting for race/ethnicity. Black non-Hispanics (HR 0.47, 95% CI 0.35, 0.65), Hispanics (HR 0.63, 95% CI 0.44, 0.89) and other race/ethnicities (HR 0.35, 95% CI 0.17, 0.73) were less likely to initiate antidepressant treatment, compared to white non-Hispanics.ConclusionsIn our cohort of HIV-infected adults depressive symptoms were common. Important disparities in the prevalence of depressive symptoms and receipt of antidepressant treatment existed by gender and race/ethnicity.
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- 2016
20. The Effect of Psychosocial Syndemic Production on 4-Year HIV Incidence and Risk Behavior in a Large Cohort of Sexually Active Men Who Have Sex With Men
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Mimiaga, Matthew J, O'Cleirigh, Conall, Biello, Katie B, Robertson, Angela M, Safren, Steven A, Coates, Thomas J, Koblin, Beryl A, Chesney, Margaret A, Donnell, Deborah J, Stall, Ron D, and Mayer, Kenneth H
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Clinical Sciences ,Drug Abuse (NIDA only) ,Clinical Trials and Supportive Activities ,Prevention ,Clinical Research ,Brain Disorders ,Substance Misuse ,Sexual and Gender Minorities (SGM/LGBT*) ,Infectious Diseases ,HIV/AIDS ,Mental Health ,Behavioral and Social Science ,Aetiology ,2.3 Psychological ,social and economic factors ,Infection ,Good Health and Well Being ,Adolescent ,Adult ,Cohort Studies ,HIV Infections ,Homosexuality ,Male ,Humans ,Incidence ,Male ,Middle Aged ,Prospective Studies ,Psychophysiologic Disorders ,Risk-Taking ,Sexual Behavior ,United States ,Young Adult ,HIV ,men who have sex with men ,psychosocial conditions ,prevention of HIV ,sexual behaviors ,Public Health and Health Services ,Virology ,Clinical sciences ,Epidemiology ,Public health - Abstract
BackgroundCross-sectional studies have suggested that co-occurring epidemics or "syndemics" of psychosocial health problems may accelerate HIV transmission among men who have sex with men (MSM) in the United States. We aimed to assess how 5 syndemic conditions (depressive symptoms, heavy alcohol use, stimulant use, polydrug use, and childhood sexual abuse) affected HIV incidence and sexual risk behavior over time.MethodsEligible men in a large prospective cohort of sexually active HIV-uninfected MSM completed HIV testing and behavioral surveys at baseline and every 6 months for 48 months. We examined interrelationships between psychosocial problems and whether these interactions increased the odds of HIV risk behaviors and risk of seroconversion over study follow-up.ResultsAmong 4295 men, prevalence of psychosocial conditions was substantial at baseline and was positively associated with each other. We identified a statistically significant positive dose-response relationship between numbers of syndemic conditions and HIV seroconversion for all comparisons (with the greatest hazard among those with 4-5 conditions, adjusted hazard ratio = 8.69; 95% confidence interval: 4.78 to 15.44). The number of syndemic conditions also predicted increased HIV-related risk behaviors over time, which mediated the syndemic-HIV seroconversion association.ConclusionsThe accumulation of syndemic psychosocial problems predicted HIV-related sexual risk behaviors and seroconversion in a large sample of US MSM. Given the high prevalence of syndemic conditions among MSM and the moderate effect sizes attained by traditional brief behavioral interventions to date, the HIV prevention agenda requires a shift toward improved assessment of psychosocial comorbidities and stronger integration with mental health and substance abuse treatment services.
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- 2015
21. The Factor Structure and Presentation of Depression Among HIV-Positive Adults in Uganda
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Psaros, Christina, Haberer, Jessica E, Boum, Yap, Tsai, Alexander C, Martin, Jeffrey N, Hunt, Peter W, Bangsberg, David R, and Safren, Steven A
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Health Services and Systems ,Health Sciences ,Mental Health ,Sexually Transmitted Infections ,Depression ,Aging ,Infectious Diseases ,Brain Disorders ,Mental Illness ,HIV/AIDS ,Clinical Research ,Behavioral and Social Science ,Mental health ,Good Health and Well Being ,Adaptation ,Psychological ,Adult ,Anti-HIV Agents ,Checklist ,Factor Analysis ,Statistical ,Female ,HIV Infections ,Humans ,Male ,Medication Adherence ,Prevalence ,Quality of Life ,Reproducibility of Results ,Rural Health ,Self Care ,Social Support ,Surveys and Questionnaires ,Uganda ,Assessment ,Validity ,Public Health and Health Services ,Social Work ,Public Health ,Public health - Abstract
Depression is one of the most prevalent psychiatric comorbidities of HIV and one of the greatest barriers to HIV self-care and adherence. Despite this, little consensus exists on how to best measure depression among people living with HIV/AIDS (PLWHA) in African settings. Measurement of depression among PLWHA may be confounded by somatic symptoms. Some research recommends excluding these items to enhance measurement validity; sensitivity may be lost with this approach. We sought to characterize depression among a cohort (N = 453) of PLWHA initiating antiretroviral therapy in Uganda via factor analysis of a widely used measure of depression, the Hopkins Symptom Checklist (HSCLD). Common factor analysis was performed, associations between HSCLD and the Mental Health subscale of the Medical Outcomes Study HIV (MOS-HIV) estimated, and a Cronbach's alpha calculated to examine validity. Factor analysis yielded two factors: (1) somatic-cognitive symptoms and (2) behavioral disengagement. Persons with more versus less advanced disease (CD4 cell count of ≤200 cells/mm(3)) showed no statistically significant differences in depression scores (1.7 vs. 1.7, P ≥ 0.5). Both factors were significantly associated with the MOS-HIV (P < .01). Factor one was highly reliable (α = .81); factor two had only modest reliability (α = .65). Somatic-cognitive symptoms of depression and disengagement from life's activities appear to be distinct components of depression in this sample. Consideration of somatic items may be valuable in identifying depression in this setting.
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- 2015
22. High Levels of Syndemics and Their Association with Adherence, Viral Non-suppression, and Biobehavioral Transmission Risk in Miami, a U.S. City with an HIV/AIDS Epidemic
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Glynn, Tiffany R., Safren, Steven A., Carrico, Adam W., Mendez, Noelle A., Duthely, Lunthita M., Dale, Sannisha K., Jones, Deborah L., Feaster, Daniel J., and Rodriguez, Allan E.
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- 2019
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23. Site Nurse–Initiated Adherence and Symptom Support Telephone Calls for HIV-Positive Individuals Starting Antiretroviral Therapy, ACTG 5031: Substudy of ACTG 384
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Robbins, Gregory K, Testa, Marcia A, Su, Max, Safren, Steven A, Morse, Gene, Lammert, Sara, Shafer, Robert W, Reynolds, Nancy R, and Chesney, Margaret A
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Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Clinical Trials and Supportive Activities ,Infectious Diseases ,HIV/AIDS ,Behavioral and Social Science ,Management of diseases and conditions ,7.1 Individual care needs ,Infection ,Adult ,Anti-HIV Agents ,Female ,HIV Infections ,Humans ,Male ,Nurses ,Patient Compliance ,Telephone ,adherence intervention ,antiretroviral therapy ,human immunodeficiency virus ,nursing telephone support ,randomized controlled trial - Abstract
BackgroundEffective and easy to implement interventions to improve adherence to antiretroviral therapy are needed.ObjectiveTo compare site nurse-initiated adherence and symptom support telephone calls for HIV-positive individuals starting antiretroviral therapy to the study site's standard of care.MethodsA randomized controlled trial of site nurse-initiated adherence and symptom support telephone calls for HIV-positive individuals starting antiretroviral therapy. Subjects were randomized to receive site nurse-initiated telephone calls (intervention) or no additional calls to the site's standard of care (control). Subjects received calls 1 to 3 days after initiating antiretrovirals, on weeks 1, 2, 3, 6, 10, 14, 18, 22, and 26, and every 8 weeks thereafter. Self-reported adherence was captured during study visits.ResultsA total of 333 subjects starting antiretrovirals as part of ACTG 384 were co-enrolled into ACTG 5031. Subjects were followed for up to 160 weeks and were contacted for 74% of scheduled calls. There was no significant difference in proportion of patients with ≯95% mean total adherence (87.9% and 91.2%; P = .34) and mean self-reported total adherence (97.9% and 98.4%) in the intervention and control groups, respectively, or in symptom distress and clinical endpoints.ConclusionsIn the context of a clinical trial where self-reported adherence was exceptionally high, the site nurse-initiated telephone calls did not further improve self-reported adherence, symptom distress, or clinical outcomes.
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- 2013
24. Does effective depression treatment alone reduce secondary HIV transmission risk? Equivocal findings from a randomized controlled trial.
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Tsai, Alexander C, Mimiaga, Matthew J, Dilley, James W, Hammer, Gwendolyn P, Karasic, Dan H, Charlebois, Edwin D, Sorensen, James L, Safren, Steven A, and Bangsberg, David R
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Humans ,HIV Infections ,Fluoxetine ,Antidepressive Agents ,Second-Generation ,Risk Assessment ,Follow-Up Studies ,Depression ,Risk-Taking ,Sexual Behavior ,Comorbidity ,Adult ,Middle Aged ,Homeless Persons ,Sexual Partners ,Referral and Consultation ,San Francisco ,Female ,Male ,HIV ,Antidepressive agents ,Sexual behavior ,Protected sex ,Homeless persons ,Antidepressive Agents ,Second-Generation ,Pediatric AIDS ,HIV/AIDS ,Brain Disorders ,Mental Health ,Pediatric ,Prevention ,Behavioral and Social Science ,Clinical Research ,Sexually Transmitted Infections ,Clinical Trials and Supportive Activities ,6.1 Pharmaceuticals ,Infection ,Public Health ,Public Health and Health Services ,Social Work - Abstract
Depressed mood has been associated with HIV transmission risk behavior. To determine whether effective depression treatment could reduce the frequency of sexual risk behavior, we analyzed secondary outcome data from a 36-week, two-arm, parallel-design, randomized controlled trial, in which homeless and marginally housed, HIV-infected persons with comorbid depressive disorders were randomized to receive either: (a) directly observed treatment with the antidepressant medication fluoxetine, or (b) referral to a local public mental health clinic. Self-reported sexual risk outcomes, which were measured at 3, 6, and 9 months, included: total number of sexual partners, unprotected sexual intercourse, unprotected sexual intercourse with an HIV-uninfected partner or a partner of unknown serostatus, and transactional sex. Estimates from generalized estimating equations regression models did not suggest consistent reductions in sexual risk behaviors resulting from treatment. Mental health interventions may need to combine depression treatment with specific skills training in order to achieve durable impacts on HIV prevention outcomes.
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- 2013
25. Cognitive and Behavioral Contributions to Depression Severity, Quality of Life, and Functioning Among People Living With HIV in South Africa
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Andersen, Lena S., Stanton, Amelia M., Magidson, Jessica F., Joska, John A., O'Cleirigh, Conall, Lee, Jasper S., Kagee, Ashraf, Witten, Jade A., and Safren, Steven A.
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THINKING TOO ,HIV ,rumination ,CARE ,VALIDATION ,PREVALENCE ,ACTIVATION ,South Africa ,Clinical Psychology ,ANTIRETROVIRAL THERAPY ,COMMON MENTAL-DISORDERS ,depression ,HIV/AIDS ,INCOME COUNTRIES ,behavioral activation ,SCALE - Abstract
Cognitive-behavioral treatments for depression typically address both behavioral (e.g., activation) and cognitive (e.g., rumination) components, and consequently improve quality of life (QOL) and function in high-resource settings. However, little is known about the cross-cultural applicability and relative contribution of these components to depression symptom severity, QOL, and functional impairment in South Africa and other resource-limited global settings with high HIV prevalence rates.Persons with HIV (N = 274) from a peri-urban community outside Cape Town, South Africa, were administered multiple measures of depression (Hamilton Depression Scale, Centre for Epidemiological Studies Depression Scale, South African Depression Scale), cognitive and behavioral components related to depression (Ruminative Response Scale, Behavioral Activation for Depression Scale), and measures of QOL and functioning (Sheehan Disability Scale, Quality of Life Enjoyment and Satisfaction Scale—Short Form). Multiple linear regression models were fit to assess the relative contribution of behavioral and cognitive components to depression severity, QOL, and functional impairment in this population.Models accounting for age and sex revealed that lower levels of behavioral activation (BA) were significantly associated with all measures of depression, as well as with QOL and functional impairment (all ps The consistent and unique association of BA with depression, QOL, and functional impairment bolsters its importance as a treatment target for this population. Cognitive-behavioral treatments for depression typically address both behavioral (e.g., activation) and cognitive (e.g., rumination) components, and consequently improve quality of life (QOL) and function in high-resource set-tings. However, little is known about the cross-cultural applicability and relative contribution of these components to depression symptom severity, QOL, and functional impairment in South Africa and other resource-limited glo-bal settings with high HIV prevalence rates.Persons with HIV (N = 274) from a peri-urban community outside Cape Town, South Africa, were administered mul-tiple measures of depression (Hamilton Depression Scale, Centre for Epidemiological Studies Depression Scale, South African Depression Scale), cognitive and behavioral com-ponents related to depression (Ruminative Response Scale, Behavioral Activation for Depression Scale), and measures of QOL and functioning (Sheehan Disability Scale, Quality of Life Enjoyment and Satisfaction Scale-Short Form). Multiple linear regression models were fit to assess the rel-ative contribution of behavioral and cognitive components to depression severity, QOL, and functional impairment in this population.Models accounting for age and sex revealed that lower levels of behavioral activation (BA) were significantly asso-ciated with all measures of depression, as well as with QOL and functional impairment (all ps < .01). Rumination was associated with all measures of depression (all ps < .01), but not with QOL or functional impairment.The consistent and unique association of BA with depres-sion, QOL, and functional impairment bolsters its impor-tance as a treatment target for this population.
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- 2023
26. Longitudinal Effects of Syndemics on HIV-Positive Sexual Minority Men’s Sexual Health Behaviors
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Harkness, Audrey, Bainter, Sierra A., O’Cleirigh, Conall, Albright, Christopher, Mayer, Kenneth H., and Safren, Steven A.
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- 2019
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27. Efficacy and Safety of Three Antiretroviral Regimens for Initial Treatment of HIV-1: A Randomized Clinical Trial in Diverse Multinational Settings
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Campbell, Thomas B, Smeaton, Laura M, Kumarasamy, N, Flanigan, Timothy, Klingman, Karin L, Firnhaber, Cynthia, Grinsztejn, Beatriz, Hosseinipour, Mina C, Kumwenda, Johnstone, Lalloo, Umesh, Riviere, Cynthia, Sanchez, Jorge, Melo, Marineide, Supparatpinyo, Khuanchai, Tripathy, Srikanth, Martinez, Ana I, Nair, Apsara, Walawander, Ann, Moran, Laura, Chen, Yun, Snowden, Wendy, Rooney, James F, Uy, Jonathan, Schooley, Robert T, De Gruttola, Victor, Hakim, James Gita, Swann, Edith, Barnett, Ronald L, Brizz, Barbara, Delph, Yvette, Gettinger, Nikki, Mitsuyasu, Ronald T, Eshleman, Susan, Safren, Steven, Fiscus, Susan A, Andrade, Adriana, Haas, David W, Amod, Farida, Berthaud, Vladimir, Bollinger, Robert C, Bryson, Yvonne, Celentano, David, Chilongozi, David, Cohen, Myron, Collier, Ann C, Currier, Judith Silverstein, Cu-Uvin, Susan, Eron, Joseph, Flexner, Charles, Gallant, Joel E, Gulick, Roy M, Hammer, Scott M, Hoffman, Irving, Kazembe, Peter, Kumwenda, Newton, Lama, Javier R, Lawrence, Jody, Maponga, Chiedza, Martinson, Francis, Mayer, Kenneth, Nielsen, Karin, Pendame, Richard B, Ramratnam, Bharat, Sanne, Ian, Severe, Patrice, Sirisanthana, Thira, Solomon, Suniti, Tabet, Steve, Taha, Taha, van der Horst, Charles, Wanke, Christine, Gormley, Joan, Marcus, Cheryl J, Putnam, Beverly, Loeliger, Edde, Pappa, Keith A, Webb, Nancy, Shugarts, David L, Winters, Mark A, Descallar, Renard S, Steele, Joseph, Wulfsohn, Michael, Said, Farideh, Chen, Yue, Martin, John C, Bischofberger, Norbert, Cheng, Andrew, Jaffe, Howard, Sharma, Jabin, Poongulali, S, Cardoso, Sandra Wagner, Faria, Deise Lucia, Berendes, Sima, Burke, Kelly, Mngqibisa, Rosie, Kanyama, Cecelia, Kayoyo, Virginia, Samaneka, Wadzanai P, Chisada, Anthony, and Faesen, Sharla
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Biomedical and Clinical Sciences ,Clinical Sciences ,Patient Safety ,Infectious Diseases ,Comparative Effectiveness Research ,HIV/AIDS ,Clinical Trials and Supportive Activities ,Clinical Research ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Infection ,Anti-HIV Agents ,Antiretroviral Therapy ,Highly Active ,Coinfection ,Drug Therapy ,Combination ,Female ,Follow-Up Studies ,HIV Infections ,HIV-1 ,Humans ,Internationality ,Male ,Mycobacterium tuberculosis ,Pregnancy ,Time Factors ,Treatment Outcome ,Withholding Treatment ,PEARLS study team of the ACTG ,Medical and Health Sciences ,General & Internal Medicine ,Biomedical and clinical sciences ,Health sciences - Abstract
BackgroundAntiretroviral regimens with simplified dosing and better safety are needed to maximize the efficiency of antiretroviral delivery in resource-limited settings. We investigated the efficacy and safety of antiretroviral regimens with once-daily compared to twice-daily dosing in diverse areas of the world.Methods and findings1,571 HIV-1-infected persons (47% women) from nine countries in four continents were assigned with equal probability to open-label antiretroviral therapy with efavirenz plus lamivudine-zidovudine (EFV+3TC-ZDV), atazanavir plus didanosine-EC plus emtricitabine (ATV+DDI+FTC), or efavirenz plus emtricitabine-tenofovir-disoproxil fumarate (DF) (EFV+FTC-TDF). ATV+DDI+FTC and EFV+FTC-TDF were hypothesized to be non-inferior to EFV+3TC-ZDV if the upper one-sided 95% confidence bound for the hazard ratio (HR) was ≤1.35 when 30% of participants had treatment failure. An independent monitoring board recommended stopping study follow-up prior to accumulation of 472 treatment failures. Comparing EFV+FTC-TDF to EFV+3TC-ZDV, during a median 184 wk of follow-up there were 95 treatment failures (18%) among 526 participants versus 98 failures among 519 participants (19%; HR 0.95, 95% CI 0.72-1.27; p = 0.74). Safety endpoints occurred in 243 (46%) participants assigned to EFV+FTC-TDF versus 313 (60%) assigned to EFV+3TC-ZDV (HR 0.64, CI 0.54-0.76; p
- Published
- 2012
28. Mechanism of Change in Cognitive Behavioral Therapy for Body Image and Self-Care on ART Adherence Among Sexual Minority Men Living with HIV
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Lamb, Kalina M., Nogg, Kelsey A., Safren, Steven A., and Blashill, Aaron J.
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- 2018
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29. Body Image and Condomless Anal Sex Among Sexual Minority Men Living with HIV
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Gholizadeh, Shadi, Rooney, Benjamin M., Merz, Erin L., Malcarne, Vanessa L., Safren, Steven A., and Blashill, Aaron J.
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- 2018
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30. The Relationship Between Automatic Thoughts and Depression in a Cognitive-Behavioral Treatment for People Living with HIV/AIDS: Exploring Temporality and Causality
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Riley, Kristen E., Lee, Jasper S., and Safren, Steven A.
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- 2017
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31. Pathways Between Intersectional Stigma and HIV Treatment Engagement Among Men Who Have Sex with Men (MSM) in India.
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Bhutada, Kiran, Chakrapani, Venkatesan, Gulfam, Fazlur R., Ross, Jonathan, Golub, Sarit A., Safren, Steven A., Prasad, Rita, and Patel, Viraj V.
- Abstract
In India and other low-and-middle-income countries, little is known about how intersectional stigma affects MSM engagement in ART. Informed by the Health Stigma and Discrimination Framework, we qualitatively examined how multiple stigmas influence ART engagement among Indian MSM. We conducted 3 focus groups (N = 22) with MSM living with HIV, aged 21–58 years, in Delhi and Hyderabad to identify potential intervention targets and solutions to improve treatment outcomes. Framework analysis and techniques were used to code and analyze translated audio-recordings. Findings revealed enacted stigma, associated with HIV and MSM identity, manifested as familial shame and healthcare discrimination, inhibiting access to support, and decreasing HIV care engagement. Anticipated stigma led to worry about disclosure and societal repercussions. Community-Based-Organizations, ART centers, and family members were primary sources of support, leading to increased ART initiation and retention. Potential solutions included using MSM peer-counselors, increasing social support, and providing HIV education to the general community. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
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32. Technology-Delivered Mental Health Interventions for People Living with HIV/AIDS (PLWHA): a Review of Recent Advances
- Author
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Kempf, Mirjam-Colette, Huang, Chao-Hui, Savage, Robert, and Safren, Steven A.
- Published
- 2015
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33. Can behavioral theory inform the understanding of depression and medication nonadherence among HIV-positive substance users?
- Author
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Magidson, Jessica F., Listhaus, Alyson, Seitz-Brown, C. J., Safren, Steven A., Lejuez, C. W., and Daughters, Stacey B.
- Published
- 2015
- Full Text
- View/download PDF
34. The Unique Challenges Facing HIV-Positive Patients Who Smoke Cigarettes: HIV Viremia, Art Adherence, Engagement in HIV care, and Concurrent Substance Use
- Author
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O’Cleirigh, Conall, Valentine, Sarah E., Pinkston, Megan, Herman, Debra, Bedoya, C. Andres, Gordon, Janna R., and Safren, Steven A.
- Published
- 2015
- Full Text
- View/download PDF
35. Body Mass Index, Depression, and Condom Use Among HIV-Infected Men who have Sex with Men: A Longitudinal Moderation Analysis
- Author
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Blashill, Aaron J., Mayer, Kenneth H., Crane, Heidi M., Baker, Joshua S., Willig, James H., Willig, Amanda L., Grasso, Chris, O’Cleirigh, Conall, and Safren, Steven A.
- Published
- 2014
- Full Text
- View/download PDF
36. Depression longitudinally mediates the association of appearance concerns to ART non-adherence in HIV-infected individuals with a history of injection drug use
- Author
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Blashill, Aaron J., Gordon, Janna R., and Safren, Steven A.
- Published
- 2014
- Full Text
- View/download PDF
37. Examining the Correspondence Between Relationship Identity and Actual Sexual Risk Behavior Among HIV-Positive Men Who Have Sex with Men
- Author
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Blashill, Aaron J., Wilson, Johannes M., O’Cleirigh, Conall M., Mayer, Kenneth H., and Safren, Steven A.
- Published
- 2014
- Full Text
- View/download PDF
38. Factors Associated with Post-Exposure Prophylaxis Awareness Among Latino Sexual Minority Men in South Florida.
- Author
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Weinstein, Elliott R., Lozano, Alyssa, Jones, Megan A., Safren, Steven A., and Harkness, Audrey
- Subjects
HIV prevention ,DATA science ,HISPANIC Americans ,CROSS-sectional method ,MEN ,REGRESSION analysis ,HEALTH literacy ,SELF-efficacy ,GENDER identity ,SEXUAL minorities ,DESCRIPTIVE statistics ,LITERATURE reviews ,SECONDARY analysis - Abstract
Despite their efficacy, biomedical HIV prevention tools such as post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) have been insufficiently scaled up and disseminated, especially among marginalized subgroups that face substantial HIV disparities. Given the minimal literature available on PEP among Latino sexual minority men (LSMM), this cross-sectional secondary analysis explored factors associated with PEP awareness among a group of LSMM living in South Florida, a US HIV epicenter. The parent study examined patterns of engagement in PrEP and behavioral health treatment services among LSMM (N = 290). The current secondary analysis (N = 243) identified factors associated with PEP awareness using three methods: stochastic search variable selection, participatory data science, and literature review—before being modeled using linear regression. Most participants (67.5%) reported having little to no awareness about PEP before initiating our study. Simple linear regression models suggested that higher PrEP knowledge (B = 0.17, SE = 0.02, p < 0.001), HIV knowledge (B = 0.15, SE = 0.04, p < 0.001), PrEP self-efficacy (B = 0.37, SE = 0.13, p < 0.05), and high perceived community norms for HIV testing (B = 0.29, SE = 0.14, p < 0.05) were each associated with LSMM's greater PEP awareness, while identity affirmation was associated with less PEP awareness (B = −0.13, SE = 0.05, p < 0.01). Results suggest the utility of our three-pronged variable selection approach and address gaps in PEP awareness and use among LSMM living in a US HIV epicenter to support Ending the HIV Epidemic goals. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
39. A Preliminary RCT of CBT-AD for Adherence and Depression Among HIV-Positive Latinos on the U.S.-Mexico Border: The Nuevo Día Study
- Author
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Simoni, Jane M., Wiebe, John S., Sauceda, John A., Huh, David, Sanchez, Giselle, Longoria, Virginia, Andres Bedoya, C., and Safren, Steven A.
- Published
- 2013
- Full Text
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40. Physical Activity and Health Outcomes Among HIV-Infected Men Who Have Sex with Men: A Longitudinal Mediational Analysis
- Author
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Blashill, Aaron J., Mayer, Kenneth H., Crane, Heidi, Magidson, Jessica F., Grasso, Chris, Mathews, W. Christopher, Saag, Michael S., and Safren, Steven A.
- Published
- 2013
- Full Text
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41. Substance Use Predictors of Poor Medication Adherence: The Role of Substance Use Coping Among HIV-Infected Patients in Opioid Dependence Treatment
- Author
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Gonzalez, Adam, Mimiaga, Matthew J., Israel, Jared, Andres Bedoya, C., and Safren, Steven A.
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- 2013
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42. Body Mass Index, Depression and Sexual Transmission Risk Behaviors Among HIV-Positive MSM
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Blashill, Aaron J., O’Cleirigh, Conall, Mayer, Kenneth H., Goshe, Brett M., and Safren, Steven A.
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- 2012
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43. Patterns of Substance Use Among a Large Urban Cohort of HIV-Infected Men Who Have Sex With Men in Primary Care
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Skeer, Margie R., Mimiaga, Matthew J., Mayer, Kenneth H., O’Cleirigh, Conall, Covahey, Charles, and Safren, Steven A.
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- 2012
- Full Text
- View/download PDF
44. Mental Health: A Focus on Stress, Coping, and Mental Illness as it Relates to Treatment Retention, Adherence, and Other Health Outcomes
- Author
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Blashill, Aaron J., Perry, Nicholas, and Safren, Steven A.
- Published
- 2011
- Full Text
- View/download PDF
45. Neurocognitive impairment and medication adherence in HIV patients with and without cocaine dependence
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Meade, Christina S., Conn, Nina A., Skalski, Linda M., and Safren, Steven A.
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- 2011
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46. Challenges in Addressing Depression in HIV Research: Assessment, Cultural Context, and Methods
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Simoni, Jane M., Safren, Steven A., Manhart, Lisa E., Lyda, Karen, Grossman, Cynthia I., Rao, Deepa, Mimiaga, Matthew J., Wong, Frank Y., Catz, Sheryl L., Blank, Michael B., DiClemente, Ralph, and Wilson, Ira B.
- Published
- 2011
- Full Text
- View/download PDF
47. A longitudinal investigation of the impact of life stress on HIV treatment adherence
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Bottonari, Kathryn A., Safren, Steven A., McQuaid, John R., Hsiao, Chiu-Bin, and Roberts, John E.
- Published
- 2010
- Full Text
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48. Latinos and HIV/AIDS: Examining Factors Related to Disparity and Identifying Opportunities for Psychosocial Intervention Research
- Author
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Gonzalez, Jeffrey S., Hendriksen, Ellen Setsuko, Collins, Erin Marie, Durán, Ron E., and Safren, Steven A.
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- 2009
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49. Predictors of Identifying as a Barebacker among High-Risk New England HIV Seronegative Men Who Have Sex with Men
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Reisner, Sari L., Mimiaga, Matthew J., Case, Patricia, Johnson, Carey V., Safren, Steven A., and Mayer, Kenneth H.
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- 2009
- Full Text
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50. Developing an HIV-Prevention Intervention for HIV-Infected Men Who Have Sex with Men in HIV Care: Project Enhance
- Author
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Knauz, Robert O., Safren, Steven A., O’Cleirigh, Conall, Capistrant, Beatrix D., Driskell, Jeff R., Aguilar, Daniel, Salomon, Liz, Hobson, Jeremy, and Mayer, Kenneth H.
- Published
- 2007
- Full Text
- View/download PDF
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