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To estimate the effect of neighborhood-level modification on the efficacy of the MyPEEPS Mobile intervention on the reduction of condomless anal sex acts among same-sex attracted adolescent men. A series of generalized linear mixed model was used to examine if the effect of the MyPEEPS Mobile intervention on condomless anal sex acts was moderated by neighborhood-level factors using data from the 2019 American Community Survey US Census Bureau. The magnitudes of intervention were significantly smaller at both 6- and 9-month follow-up among adolescents living in neighborhood with high proportions of Hispanic or Latino residents (IRR6M = 1.02, 95 % CI: 1.01, 1.02; IRR9M = 1.03, 95 % CI: 1.01, 1.05) and high proportions of families with income below the poverty level (IRR6M = 1.07, 95 % CI: 1.01, 1.12; IRR9M = 1.05, 95 % CI: 1.01, 1.10), which indicated that living in communities with a higher concentration of residents living under poverty or of Hispanic/and Latino ethnicity significantly modified the effective of program intervention on condomless sex among adolescent MSM. Understanding how neighborhood characteristics modify the effect of HIV prevention interventions may be useful in better targeting delivery and tailoring content of interventions based on neighborhood level characteristics such as the ones identified in this study.

Studies on HIV self-testing (HIV-ST) have been limited to adults (age 18+). The study assessed use of HIV-ST among a diverse group of young men who have sex with men (YMSM) in the United States (US) and assessed differences in uptake by demographic characteristics and requirements for parental consent. This study demonstrated feasibility of HIV-ST for YMSM as young as 14 years of age, which suggests potential for increasing HIV testing in this young age group and promoting health equity.

The COVID-19 pandemic has disrupted sexual health services among those most vulnerable to HIV acquisition, such as adolescent men who have sex with men (AMSM). We sought to characterize the changes in sexual-risk behaviors, HIV and other STI testing, and pre-exposure prophylaxis (PrEP) use among a longitudinal cohort of AMSM aged 13 to 18 years before and during the COVID-19 pandemic. We observed a significant decline in HIV testing and a marginal decrease in other STI testing since the pandemic began in March 2020. Outreach efforts and innovative remote delivery of sexual health services are needed to support access to healthcare services among AMSM as the pandemic persists.

Purpose: This study examined factors associated with past-year health care utilization among young gay, bisexual, and other men who have sex with men (YMSM) using Andersens behavioral model of health service use. Methods: From 2018 to 2020, 751 YMSM (aged 13-18) recruited online and offline for the MyPEEPS mHealth HIV prevention study completed an online survey. Hierarchical logistic regression models assessed associations between past-year health care utilization (i.e., routine checkup) and predisposing (parental education, race/ethnicity, age, and internalized homonegativity), enabling (health literacy, health care facility type, U.S. Census Divisions), and need factors (ever testing for HIV). Results: The sample included 31.8% Hispanic, 23.9% White, and 14.6% Black YMSM; median age was 16. Most (75%) reported past-year health care utilization, often from private doctors offices (29.1%); 6% reported no regular source of care. In the final regression model, higher odds of past-year health care utilization were found for younger participants (age 13-14, adjusted odds ratio [AOR] = 1.91; 95% confidence interval [CI]: 1.07-3.43; age 15-16 AOR = 1.55; 95% CI: 1.04-2.30; reference: 17-18) and those with increasing health literacy (AOR = 1.71; 95% CI: 1.36-2.16). YMSM with lower parental education had lower odds of past-year health care utilization (AOR = 0.56; 95% CI: 0.38-0.84), as did those relying on urgent care facilities (AOR = 0.60; 95% CI: 0.41-0.87; reference: routine care facilities) and those who identified as Mixed/Other race (AOR = 0.50; 95% CI: 0.28-0.91; reference: White). Conclusions: Findings highlight opportunities to intervene in YMSMs health risk trajectory before age 17 to reduce drop-off in routine health care utilization. Interventions to improve routine health care utilization among YMSM may be strengthened by building resilience (e.g., health literacy) while removing barriers maintained through structural disadvantage, including equity in education. Clinical Trial Registration Number: NCT03167606.

PURPOSE: Research suggests social support may protect sexual minorities from the harmful effects of victimization that undermine mental and sexual health wellness; however, this relationship has been underexplored among a diverse youth population. We examined the association between lifetime homonegative victimization, perceived stress in the last month, and resilience factors among a diverse sample of adolescent sexual minority males. METHODS: Data were collected between June 2018 and April 2020 as part of the MyPEEPS Mobile study, a multi-site randomized controlled trial evaluating the effectiveness of a mobile behavioral HIV prevention intervention for adolescents living in the U.S. We analyzed baseline survey data from 542 sexual minority males, aged 13-18 years. We used bivariate analyses to examine relationships among variables and multivariable linear regression models to determine if resilience factors attenuated the association between homonegative victimization and perceived stress. RESULTS: Perceived stress was positively associated with younger age, internalized homophobia, experiencing verbal victimization, threats of being outed, and threats of physical violence. Relying on online friends for support and having good family relations both attenuated the relationship between verbal victimization and perceived stress. However, neither of these resilience factors significantly weakened the associations between perceived stress, threats of physical violence, and being outed. CONCLUSION: Resilience factors, including peer and family support, may play an attenuating role in the relationship between homonegative victimization and perceived stress among adolescent sexual minority males.

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.

BackgroundTo obtain optimal health outcomes, persons living with human immunodeficiency virus (HIV) must be retained in clinical care. We examined the relationships between 4 possible combinations of 2 separate retention measures (missed visits and the Institute of Medicine [IOM] indicator) and all-cause mortality.MethodsThe sample included 4162 antiretroviral therapy (ART)-naive patients who started ART between January 2000 and July 2010 at any of 5 US sites of the Center for AIDS Research Network of Integrated Clinical Systems. The independent variable of interest was retention, captured over the 12-month period after the initiation of ART. The study outcome, all-cause mortality 1 year after ART initiation, was determined by querying the Social Security Death Index or the National Death Index. We evaluated the associations of the 4 categories of retention with all-cause mortality, using the Cox proportional hazards models.ResultsTen percent of patients did not meet retention standards for either measure (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.59-3.21). Patients retained by the IOM but not the missed-visits measure (42%) had a higher HR for mortality (1.72; 95% CI, 1.33-2.21) than patients retained by both measures (41%). Patients retained by the missed-visits but not the IOM measure (6%) had the same mortality hazards as patients retained by both measures (HR, 1.01; 95% CI, .54-1.87).ConclusionsMissed visits within the first 12 months of ART initiation are a major risk factor for subsequent death. Incorporating missed visits in clinical and public health retention and viral suppression programming is advised.

As people with HIV live longer and healthier, it has become more likely that they will assume a caregiver role for their families and/or friends. Yet, there is a significant gap in the literature that older caregivers with HIV (OCWH) have not received attention from practitioners and researchers. To fill the gap, our qualitative study was conducted with OCWH (N = 19) to explore various themes such as adjustment to caregiving, caregiving responsibilities, HIV and other health issues, support systems, caregiving outcomes, needs assessment, cognitive health, and the impact of COVID-19. Results indicated that each OCWH faced their own unique challenges (e.g., severity of health conditions, intense caregiving responsibilities, caregiving situation, lack of social support/ transportation/financial means), but they expressed positive and fulfilling caregiving outcomes. Understanding the lived experiences of OCWH is requisite to develop holistic service programs to meet their caregiving needs while supporting their HIV health and cooccurring health conditions. [ABSTRACT FROM AUTHOR]

Introduction: There is an urgent need to identify men who have sex with men (MSM) living with HIV with unsuppressed viral loads to prevent transmission. Though respondent-driven sampling (RDS) is traditionally used for hard-to-reach populations, we compare how RDS and direct recruitment (DR) perform in identifying MSM living with HIV with unsuppressed viralloads and identifying MSM with socio-demographics characteristic of hard-to-reach populations. Methods: This is a cross-sectionalanalysis among 1305 MSM who were recruited from March 2016 to December 2017 for a case management intervention trial(HPTN 078). We recruited participants across four cities using RDS and DR methods: Birmingham, AL; Atlanta, GA; Baltimore, MD; and Boston, MA. Participants completed a socio-demographic questionnaire and underwent HIV testing. We compare the proportion of MSM with HIV and unsuppressed viralloads (HIV RNA [greater than or equal to] 1000 copies/ml) based on recruitment method using Pearson chi-square tests. We also compare differences in race, income, healthcare coverage, education, sexual orientation, hidden sexuality and comfort with participating in the LGBT community between recruitment methods and perform non-parametric trend tests to see how demographics change across RDS recruitment waves. Results: RDS recruited 721 men (55.2%) and DR yielded 584 men (44.8%). Overall, 69% were living with HIV, of whom 18% were not virally suppressed. HIV prevalence was higher among those recruited via DR (84%) compared to RDS (58%), p < 0.0001. Twenty per cent of DR recruits were not virally suppressed compared to 15% of RDS, though this was not significant. DR yielded a significantly higher proportion of Black participants and those with less than a high school diploma. The prevalence of low income, no healthcare coverage, bisexuality and hidden sexuality increased across RDS waves. Conclusions: DR was more efficient in identifying MSM living with HIV with unsuppressed viral loads; however, there was a higher proportion of hard-to-reach MSM who were low income, lacked health coverage, were bisexual and were not open with their sexuality in deeper waves of RDS. Researchers should consider supplementing RDS recruitment with DR efforts if aiming to identify MSM with unsuppressed viral loads via RDS. Keywords: ARV; co-infection; HIV epidemiology; men who have sex with men; recruitment; viral suppression, 1 | INTRODUCTION The HIV epidemic in the United States has disproportionately affectedgay,bisexual and other men who have sex with men (MSM) since the first cases were identified in the [...]

People experiencing homelessness are at increased risk for HIV, and people with HIV (PWH) experiencing homelessness are more likely to experience suboptimal HIV health outcomes than PWH with stable housing. Within Alabama, a state prioritized in the Ending the HIV Epidemic initiative, Jefferson County consistently has the highest number of new HIV diagnoses as well as a high percentage of the state's homeless population. To address the twin epidemics of both HIV and homelessness within the high-priority setting of Jefferson County, Alabama, this 1-year community-based project, Ending the HIV Epidemic: Addressing HIV Health and Homelessness (AH3), sought to increase HIV testing and linkage to care among this population by placing a full-time case manager trained in HIV testing and case management at a homeless shelter. Results demonstrated that HIV testing was highly acceptable: 733 individuals were offered a test, and only 2.7% (n = 20) declined. Nine previously diagnosed, out of care PWH and one newly diagnosed PWH were identified through AH3 testing efforts. Of these, five (50%) were linked to care at a local HIV clinic. The remaining five PWH left the shelter before they could be linked to care. Just 10 shelter guests expressed interest in taking PrEP (just 1.4% of guests who tested negative for HIV), and only one of these linked to PrEP care. Future health promotion programs are needed to address mental health and other ancillary needs among this population, as well as programs that provide access to PrEP and other HIV prevention services. [ABSTRACT FROM AUTHOR]

BackgroundEvaluation of the time from HIV diagnosis to viral suppression (VS) captures the collective effectiveness of HIV prevention and treatment activities in a given locale and provides a more global estimate of how effectively the larger HIV care system is working in a given geographic area or jurisdiction. ObjectiveThis study aimed to evaluate temporal and geographic variability in VS among persons with newly diagnosed HIV infection in Alabama between 2012 and 2014. MethodsWith data from the National HIV Surveillance System, we evaluated median time from HIV diagnosis to VS (

Alabama depends heavily on Ryan White HIV/AIDS Program (RWHAP) funding, yet patient enrollment at one large, RWHAP-funded, academically-affiliated HIV clinic in Alabama has steadily increased each year, with approximately 20% bypassing more proximal RWHAP clinics. To understand reasons why patients travel long distances and bypass closer clinics to receive care, we conducted eight focus groups over Zoom, each containing between 2–3 participants (n = 18) and applied thematic analysis to code the data. Primary themes included: (1) Reasons for Traveling Long Distances to Receive HIV Medical Care, (2) Experiences with HIV Medical Care during the COVID-19 Pandemic, and (3) Travel Challenges. Some participants were attracted by the clinic's one-stop-shop model, while others eschewed local clinics to avoid status disclosure. An overarching travel challenge was lack of transportation, yet most participants favored in-person appointments over telehealth despite driving long distances. Future research should explore patient attitudes towards telehealth in greater depth. [ABSTRACT FROM AUTHOR]

This study examined the role of partnership status (married, unmarried-partnered, and unpartnered) on retention in care among newly diagnosed (2013–2017), cisgender heterosexual people with HIV in Birmingham, Alabama (n = 152). This study evaluated all scheduled HIV primary care provider visits for two years following diagnosis date. A kept-visit measure was calculated such that, if an individual attended ≥1 visit in each of the four 6-month intervals, they were considered to have high visit constancy. A missed-visit measure was categorized as ≥1 no-show vs. 0 no-show for first and second year after diagnosis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression models. Models were adjusted for confounding sociodemographic and clinical characteristics. The study population was 76% Black, 57% male, median age of 37 years. Overall, 65% had high visit consistency and 34.5% had ≥1 no-show in both years. Compared to unpartnered, married individuals had higher visit constancy [AOR (95% CI): 2.88 (1.02, 8.16)]; no differences were observed among unmarried-partnered individuals. No differences in having ≥1 no-show among partnership status groups were observed for either year. These findings suggest potential success of interventions involving a social confidant in optimizing retention in care among newly diagnosed, heterosexual PWH. [ABSTRACT FROM AUTHOR]