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Engagement in HIV care and a high level of antiretroviral therapy (ART) adherence for people living with HIV is crucial to treatment success and can minimize the population burden of the disease. Despite this, there is a critical gap in HIV prevention science around the development of interventions for serodiscordant male couples. This paper reports on the results of a randomized controlled trial to assess the efficacy of Stronger Together, a dyadic counseling intervention aimed at increasing engagement in and optimizing HIV care among serodiscordant male couples in Atlanta, GA, Boston, MA, and Chicago, IL. Between 2014 and 2017, 159 male serodiscordant couples (total N = 318) in Atlanta, GA, Boston, MA, and Chicago, IL were enrolled and equally randomized to either the Stronger Together intervention arm (a three-session dyadic intervention involving HIV testing and adherence counseling) or a standard of care (SOC) control arm. Couples completed individual study assessments via an audio computer assisted self-interviewing (ACASI) system at baseline, 6, 12 and 18 months. Primary outcomes included being prescribed and currently taking ART, and fewer missed doses of ART in the past 30 days; because the trial was not powered to examine viral suppression, we examined this as an exploratory outcome. Longitudinal data analysis was by an intention-to-treat approach. Participants ages ranged from 18 to 69 (mean = 35.9), and are predominantly white (77.5%), and college educated (68.4% earned a college degree or higher). Participants randomized to the Stronger Together arm had a significantly greater odds of being prescribed and currently taking ART over time than those in the SOC arm (at 12 months OR 2.75, 95%CI 1.35-4.67, p-value 0.020, and at 18 months OR 2.91, 95%CI 1.61-4.88, p-value 0.013). Similarly, those in the Stronger Together arm had a significantly lower odds of missing a dose of ART in the past 30 days over time compared to those in the SOC arm (at 12 months OR 0.28, 95%CI 0.09-0.81, p-value 0.019, and at 18 months OR 0.25, 95%CI 0.07-0.82, p-value 0.023). Among male couples in serodiscordant relationships, the Stronger Together intervention resulted in significantly improved HIV treatment outcomes at both 12 and 18 months of follow-up. This trial is the first to date to demonstrate evidence of efficacy for a dyadic counseling intervention and has the potential to fill a critical gap in secondary HIV prevention interventions for serodiscordant male couples.

Gay, bisexual, and other men who have sex with men (MSM) experience disproportionately high burdens of Human Papilloma Virus (HPV)-associated anal cancers. Recent focus has shifted to anorectal cancer prevention through high-resolution anoscopy (HRA); however, little is known about sexual minority men's perceptions, attitudes, or beliefs regarding HRA. We conducted 4 qualitative Focus Group Discussions (FGDs) (n = 15) with sexual minority men, focusing on their beliefs, attitudes, and perceptions of undergoing HRA. Participants discussed their experiences of HPV/HRA as influenced by both their gender and sexuality, including unawareness of HPV disease as a male health issue, challenges relating to female-oriented HPV/HRA language, conception of HPV/HRA as related to prostate health, and connecting their sexual behavior identification as "bottoms" to their need for HRA. As efforts to improve HRA knowledge, access, and uptake among sexual and gender minority communities increase, special attention should be paid to language and messaging choices around HRA.

Introduction Despite several recent studies documenting high rates of intimate partner violence (IPV) among gay and bisexual men (GBM), the literature is silent regarding GBM’s perceptions of IPV within their community. We examine GBM’s perceptions of same-sex IPV: its commonness, its severity, and the helpfulness of a hypothetical police response to a GBM experiencing IPV.Methods: We drew data from a 2011 survey of venue-recruited GBM (n¼989). Respondents were asked to describe the commonness of IPV, severity of IPV, and helpfulness of a hypothetical police response to IPV among GBM and among heterosexual women. We fitted a logistic model for the outcome of viewing the police response to a gay/bisexual IPV victim as less helpful than for a female heterosexual IPV victim. The regression model controlled for age, race/ethnicity, education, sexual orientation, employment status, and recent receipt of physical, emotional, and sexual IPV, with key covariates being internalized homophobia and experiences of homophobic discrimination.Results: The majority of respondents viewed IPV among GBM as common (54.9%) and problematic(63.8%). While most respondents had identical perceptions of the commonness (82.7%) and severity (84.1%) of IPV in GBM compared to heterosexual women, the majority of the sample (59.1%) reported perceiving that contacting the police would be less helpful for a GBM IPV victim than for a heterosexual female IPV victim. In regression, respondents who reported more lifetime experiences of homophobic discrimination were more likely to have this comparatively negative perception (odds ratio: 1.11, 95% confidence interval: 1.06, 1.17).Conclusion: The results support a minority stress hypothesis to understand GBM’s perceptions of police helpfulness in response to IPV. While IPV was viewed as both common and problematic among GBM, their previous experiences of homophobia were correlated with a learned anticipation of rejection and stigma from law enforcement. As the response to same-sex IPV grows, legal and health practitioners should ensure that laws and policies afford all protections to GBM IPV victims that are afforded to female IPV victims, and should consider methods to minimize the negative impact that homophobic stigma has upon GBM’s access of police assistance. [West J Emerg Med. 2013;14(4):354–362.]

Introduction: Recent research suggests that gay and bisexual men experience intimate partner violence (IPV) at rates comparable to heterosexual women. However, current screening tools used to identify persons experiencing IPV were largely created for use with heterosexual women. Given the high prevalence of IPV among gay and bisexual men in the United States, the lack of IPV screening tools that reflect the lived realities of gay and bisexual men is problematic. This paper describes the development of a short-form IPV screening tool intended to be used with gay and bisexual men.Methods: A novel definition of IPV, informed by formative Focus Group Discussions, was derived from a quantitative survey of approximately 1,100 venue-recruited gay and bisexual men. From this new definition, a draft IPV screening tool was created. After expert review (n=13) and cognitive interviews with gay and bisexual men (n=47), a screening tool of six questions was finalized. A national, online-recruited sample (n=822) was used to compare rates of IPV identified by the novel tool and current standard tools.Results: The six-item, short-form tool created through the six-stage research process captured a significantly higher prevalence of recent experience of IPV compared to a current and commonly used screening tool (30.7% versus 7.5%, p

Introduction: Recent research suggests that men who have sex with men (MSM) experience intimate partner violence (IPV) at significantly higher rates than heterosexual men. Few studies, however, have investigated implications of heterosexist social pressures – namely, homophobic discrimination, internalized homophobia, and heterosexism– on risk for IPV among MSM, and no previous studies have examined cross-national variations in the relationship between IPV and social pressure. This paperexamines reporting of IPV and associations with social pressure among a sample of internet-recruited MSM in the United States (U.S.), Canada, Australia, the United Kingdom, South Africa, and Brazil.Methods: We recruited internet-using MSM from 6 countries through selective banner advertisements placed on Facebook. Eligibility criteria were men age over 18 reporting sex with a man in the past year. Of the 2,771 eligible respondents, 2,368 had complete data and were included in the analysis. Threeoutcomes were examined: reporting recent experience of physical violence, sexual violence, and recent perpetration of physical violence. The analysis focused on associations between reporting of IPV and experiences of homophobic discrimination, internalized homophobia, and heteronormativity.Results: Reporting of experiencing physical IPV ranged from 5.75% in the U.S. to 11.75% in South Africa, while experiencing sexual violence was less commonly reported and ranged from 2.54% in Australia to 4.52% in the U.S. Perpetration of physical violence ranged from 2.47% in the U.S. to 5.76% in South Africa. Experiences of homophobic discrimination, internalized homophobia, and heteronormativity were found to increase odds of reporting IPV in all countries.Conclusion: There has been little data on IPV among MSM, particularly MSM living in low- and middleincome countries. Despite the lack of consensus in demographic correlates of violence reporting, heterosexist social pressures were found to significantly increase odds of reporting IPV in all countries.These findings show the universality of violence reporting amongMSMacross countries, and highlight the unique role of heteronormativity asa risk factor for violence reporting among MSM. The results demonstrate that using internet-based surveys to reachMSMis feasible for certain areas, although modified effortsmay be required to reach diverse samples of MSM. [West J Emerg Med. 2012;13(3):260–271.]

Development interest in brownfields sites has been growing steadily since the Environmental Protection Agency's (EPA) initiation of its national brownfields pilot program in the early 1990s. While, traditionally, environmental risk [...]

Background: In December 2020, due to antimicrobial resistance to N. gonorrhea (GC), CDC published updated treatment guidelines for GC, increasing the recommended dose of ceftriaxone (CTX) from 250mg to 500mg. This study uses Electronic Health Record (EHR) data from a large Midwestern health system to examine the adoption of these guidelines, including patient-level and system-level factors potentially related to delayed adoption of guidelines. Methods: All prescriptions of CTX linked to a diagnosis of GC or C. trachomatis between Jan. 2020 and Jun. 2022 were captured, with patient-level characteristics (sex, race, age) and system-level characteristics (encounter setting [ED, other outpatient, inpatient], encounter location [urban v. rural]). Prescriptions were classified as correct if the dosage was congruent with the CDC guideline for the year it was written. Bivariate analysis and Chi-square testing were performed to identify significant differences in guideline adoption. A regression model was fitted to elucidate factors related to nonadoption of CDC guidelines. Results: A total of 6,495 prescriptions met inclusion criteria, creating a largely young (65.9% aged 18-29), male (57.5%), urban (87.8%), Black (85.0%) cohort. The majority of encounters occurred in Emergency Departments (92.4%). Adoption of guidelines occurred rapidly: 2.3% of prescriptions from Nov. 2020 were 500mg CTX, versus 90.1% in Jan. 2021, with 97.2% of prescriptions meeting criteria for correct dosage. Regression modelling indicated that compared to white patients, Black patients had increased odds of receipt of correct CTX dosing (OR: 0.03, 95% CI 0.01, 0.04). However, encounters that occurred in non-ED outpatient settings or in inpatient settings both had lower odds of correct CTX dosage (OR: -0.11, 95% CI: -0.13, -0.08; OR: -0.07, 95% CI: -0.09, -0.05). Discussion: This study describes adoption of CDC guidelines for CTX dosing using a large, retrospective cohort of CTX prescriptions linked to GC/CT diagnosis within 2.5 years across a large, demographically diverse health system. While overall adoption rates were high, differences of adoption rates were identified in both patient- and system-level characteristics, suggesting overtreatment of some groups (Black) and undertreatment of others (non- ED patients). Studies of the causes of these differences may increase guideline adoption and mitigate risk of MDRO GC. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) rates are disproportionately high among sexual minority populations. Few studies have examined the plausible relationship between minority stress and IPV among men who have sex with men. This study examines the associations between IPV and three indicators of minority stress: internalized homophobia, sexuality-based discrimination, and racism, in a large venue-based sample of gay and bisexual men from Atlanta, USA. Each of the minority stress measures was found to be significantly associated with increased odds of self-reporting any form of receipt of IPV. Significant associations were also identified between perpetration of IPV and minority stressors, with most types of IPV perpetration linked to internalized homophobia. This study confirms findings in a growing body of research supporting the relationship between minority stress and increased prevalence of IPV among men who have sex with men, and points to the need to address structural factors in IPV prevention programs for male–male couples. [ABSTRACT FROM AUTHOR]

With the increasing pervasiveness of social media, the Internet has become an important venue for dating and sex. Not only does the Internet introduce a unique array of opportunities and risks for men who have sex with men (MSM), it also presents a valuable means through which to study sexual behavior. In this study, data on what men report in their online profiles were collected from two dating/hookup websites to explore possible geographical differences in men’s sexual preferences and expectations (N = 5,588). Across the 15 selected cities, significant differences emerged in reported HIV status and stated preference for safer sex (condom use). These patterns suggest important contextual and demographic variations and point to a need for targeted, population-specific interventions and further research to identify the underlying social and psychological constructs. With a better understanding of the local factors driving risky sexual behavior, health communication messages and tailored online interventions could be developed to address the needs and concerns of specific groups. [ABSTRACT FROM PUBLISHER]

The willingness of male-male dyads to use couples voluntary HIV counseling and testing (CVCT) has not been previously investigated globally among men who have sex with men (MSM). Using online advertisements, data were collected from 3245 MSM in seven countries who were ≥18 years of age and had ≥1 male sex partner in the previous 12 months. The analysis examined associations between individual characteristics and willingness to utilize CVCT. The willingness to utilize CVCT was compellingly high, ranging from 79% in Australia and UK to 90% in Brazil. Older MSM and those who reported not knowing their sero-status reported lower odds of willingness to use CVCT. The relationship between being in a relationship and willingness to use CVCT varied across countries, perhaps reflecting varied local understandings of the nature and content of CVCT. Further work is required to examine willingness to use CVCT among a more heterogeneous population of MSM, and to examine how CVCT services are locally perceived in order to provide information vital for the development of locally appropriate messages to promote CVCT for MSM. [ABSTRACT FROM PUBLISHER]

Using data from the National Survey of Adolescents (2004), we examine the community-level factors associated with early age at first sex among adolescents 14-19 years old in four African countries. Regression models are fitted separately by sex for each country for an outcome measuring early age at first sex, with a focus on community-level factors as potential influences of age on sexual debut. The community-level factors associated with adolescents' sexual debut vary widely by both country and gender. Community influences that emerge as risk or protective factors of early sexual debut include community levels of adolescent marriage, wealth, religious group affiliation, sex education, parental monitoring, reproductive health knowledge, media exposure, membership in adolescent social group, and use of alcohol. Results indicate the importance of context-specific understanding of adolescents' sexual behaviour and suggest how elements of place should be harnessed in the development of effective HIV and sexual health interventions. [ABSTRACT FROM AUTHOR]