Search

Globally, gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by HIV, but few interventions address mental health and HIV outcomes among GBMSM living with HIV. The purpose of this study was to pilot a multicomponent intervention, integrating emotional well-being (EW) and health navigation for GBMSM living with HIV in Guatemala City. We implemented a 12-month intervention, including a four-session EW component and a health navigation component among newly diagnosed and reengaged GBMSM with HIV (n = 112). We conducted socio-behavioral surveys at baseline and endline to measure patient characteristics and HIV, and mental health outcomes as well as viral load testing. We documented participation in EW sessions and used a smartphone application to track navigation mode, frequency, and content. Using first-difference estimation modeling, we assessed associations between participation in EW and navigation and mental health (depression and anxiety symptoms) and HIV outcomes (HIV treatment adherence, viral suppression). Acceptability was high for EW (86%) and navigation (99%). During the intervention, viral suppression increased significantly and anxiety and depression decreased significantly. Participation in EW sessions and greater navigation frequency and duration were associated with being suppressed, whereas higher emotional navigator support was associated with being unsuppressed. Participation in EW sessions was associated with reduced anxiety. Findings suggest that multicomponent interventions integrating individual counseling and navigation may promote EW and sustained viral suppression. Future intervention research is needed to confirm whether HIV and mental health outcomes are attributable to the intervention and to assess mechanisms of influence.

Background: Rejection from parents can lead transgender (trans) youth and young adults to experience poor health outcomes, while parental and sibling acceptance and support can be protective against poor health outcomes. The role of family in adult trans women's lives has been minimally investigated. Aim: This study aimed to explore experiences of familial rejection, acceptance, and support in the lives of trans women sex workers living with HIV in the Dominican Republic. Method: In-depth interviews were conducted with 21 trans women ages 23 to 49 in Santo Domingo in 2019. We conducted a qualitative analysis of the interviews. We developed narrative summaries and a case-based matrix to analyze data within and across participants and confirm patterns and themes in the data. Results: Familial rejection and acceptance were processes with most participants receiving acceptance from at least one family member over time as well as receiving emotional and instrumental support. Poor health outcomes influenced by rejection and lack of support included suicide attempts, depression, and substance use. Conversely, acceptance and support bolstered well-being and provided housing stability and assistance with HIV treatment. Conclusion: Family rejection and acceptance play an important role throughout the life course. Working with families to become accepting of their trans family members could improve trans women's health outcomes. [ABSTRACT FROM AUTHOR]

Men's gender role conflict and stress (GRC/S), the psychological strain they experience around fulfilling expectations of themselves as men, has been largely unexplored in HIV prevention research. We examined associations between both men's gender norms and GRC/S and three HIV risk behaviors using data from a population-based survey of 579 18-35 year-old men in rural northeast South Africa. Prevalence of sexual partner concurrency and intimate partner violence (IPV) perpetration in the last 12 months were 38.0 and 13.4%, respectively; 19.9% abused alcohol. More inequitable gender norms and higher GRC/S were each significantly associated with an increased odds of concurrency (p = 0.01; p

Purpose: Using an intersectionality framework, we compared stigma and HIV care and treatment outcomes across transgender and cisgender women sex workers living with HIV in the Dominican Republic (DR). Methods: In 2018–2019, data were collected in Santo Domingo, DR, using interviewer-administered surveys among 211 cisgender women and 100 transgender women. We used t-tests and chi-square tests to examine differences in sex work stigma, HIV stigma, and HIV care and treatment. Results: Transgender participants reported more anticipated HIV stigma (mean=13.61, standard deviation [SD]=2.39) than cisgender participants (mean=12.96, SD=2.21; p=0.018), but there were no statistically significant differences for internalized or enacted HIV stigma. Cisgender participants reported more anticipated sex work stigma (cisgender: mean=50.00, SD=9.22; transgender: mean=44.02, SD=9.54; p<0.001), but transgender women reported more enacted (cisgender: mean=49.99, SD=9.11; transgender: mean=59.93, SD=4.89; p<0.001) and internalized sex work stigma (cisgender: mean=50.00, SD=8.80; transgender: mean=57.84, SD=8.34; p<0.001), with no significant differences in resistance to sex work stigma. Cisgender women were significantly more likely to have received HIV care (cisgender: 99.53%, transgender: 91.00%, p<0.001), be currently taking antiretroviral therapy (cisgender: 96.21%, transgender: 84.00%, p<0.001), and be virally suppressed (cisgender: 76.19%, transgender: 64.00%, p=0.025). Conclusions: Transgender participants consistently had poorer HIV care and treatment outcomes compared with cisgender participants. Differences in stigma experiences between transgender and cisgender participants depended on the type of stigma. Findings reflect the intersectional nature of distinct types and forms of stigma among sex workers. Understanding the shared and unique experiences of transgender and cisgender women will improve HIV care engagement and viral suppression. [ABSTRACT FROM AUTHOR]

Gender norms and gender role conflict/stress may influence HIV risk behaviors among men; however scales measuring these constructs need further development and evaluation in African settings. We conducted exploratory and confirmatory factor analyses to evaluate the Gender Equitable Men's Scale (GEMS) and the Gender Role Conflict/Stress (GRC/S) scale among 581 men in rural northeast South Africa. The final 17-item GEMS was unidimensional, with adequate model fit and reliability (alpha = 0.79). Factor loadings were low (0.2-0.3) for items related to violence and sexual relationships. The final 24-item GRC/S scale was multidimensional with four factors: Success, power, competition; Subordination to women; Restrictive emotionality; and Sexual prowess. The scale had adequate model fit and good reliability (alpha = 0.83). While GEMS is a good measure of inequitable gender norms, new or revised scale items may need to be explored in the South African context. Adding the GRC/S scale to capture men's strain related to gender roles could provide important insights into men's risk behaviors.

Unconditional cash transfer programs are a form of structural intervention to address poverty, a "fundamental cause" of disease. Such programs increasingly aim to build resilience to sustain improved outcomes and provide a solid foundation for longer term transformations. As such, there is a need to understand what resilience means in specific contexts. The goal of this formative study was to explore local experiences of resilience and vulnerability among 11 youth-caregiver dyads (n = 22) who were beneficiaries of the Malawi Social Cash Transfer Program in Balaka district. We used a photo-elicitation approach informed by the participatory, visual methodology photovoice to guide the study and conducted an iterative content analysis using thematic coding of transcripts and photos. Participants took pictures of their daily struggles and shocks and participated in audio-recorded discussions to reflect on the photos using an adapted version of the SHOWeD method. We found that participants characterized resilience as a tireless process of using all available individual, family, and community resources "at all times" in pursuit of survival and well-being. In the context of daily struggles, resilience was an essential part of survival. Shocks, mostly health-related, were depicted through staged images candidly highlighting individual and environmental vulnerabilities. Community support was an essential component of resilience for both daily struggles and shocks. Using photo-elicitation methods facilitated an intergenerational, community-driven reflection on the meaning of resilience and the multilevel determinants of health in a context of extreme poverty. Findings can inform the design of resilience-focused cash transfer programs to improve health equity.

Formal sexuality education in schools is declining in the United States and this is disproportionately affecting adolescents in rural settings. The purpose of this qualitative study was to assess student and teacher perception of sexuality education delivered online as a potential solution to address this gap in access. Nine gender-specific group interviews were conducted with ninth grade students (n = 29) in rural North Carolina to discuss students' experience with an online sexuality education intervention called MyHealthEd. Interviews were also conducted with three health teachers at pilot schools. Students and teachers identified more benefits to online sexuality education including more student engagement and greater privacy and comfort, than drawbacks, such as too much student autonomy and less interaction with others. Online sexuality education is a promising and preferred method of delivery for sexuality education for students and health teachers, particularly in settings where trained health teachers are not available or less willing to deliver state-mandated content. The MyHealthEd intervention has the potential to increase availability of high quality health education to students across North Carolina, as well as students in other rural or underserved areas.