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Discrimination is associated with antiretroviral therapy non-adherence and reduced well-being among people with HIV. We examined the potential for coping to mediate the associations between intersectional discrimination and non-adherence and coping self-efficacy (confidence in one's ability to cope with discrimination) as a moderator that may buffer the negative effects of discrimination on non-adherence in a cross-sectional convenience sample of 82 Latino sexual minority men with HIV. In bivariate linear regressions, discrimination targeting Latino ethnic origin, undocumented residency status, and sexual orientation were each significantly associated with lower self-reported antiretroviral therapy non-adherence (percentage of prescribed doses taken in the last month) and greater use of disengagement coping (denial, substance use, venting, self-blame, behavioral disengagement). Associations between discrimination targeting Latino ethnicity and non-adherence, and discrimination targeting undocumented residency status and non-adherence, were each mediated by disengagement coping responses. Moderation analyses highlighted significant discrimination by coping self-efficacy interaction effects-both coping self-efficacy for problem solving and stopping unpleasant emotions/thoughts each moderated the associations between Latino discrimination and adherence, between undocumented residency status discrimination and adherence, and between HIV discrimination and adherence. Coping self-efficacy for getting social support moderated the association between undocumented residency status discrimination and adherence. Further, the interaction coefficients across models indicated that the negative effects of discrimination on adherence were attenuated at higher levels of coping self-efficacy. Findings highlight the need for structural interventions that reduce-and ultimately eliminate-discrimination, and interventions that address the harmful effects of discrimination and adherence improvement interventions to enhance coping skills among people faced with intersectional discrimination., Author(s): Joanna L. Barreras [sup.1] [sup.2] , Laura M. Bogart [sup.3] , Sarah MacCarthy [sup.4] , David J. Klein [sup.3] , David W. Pantalone [sup.5] [sup.6] Author Affiliations: (1) https://ror.org/0080fxk18, [...]

Despite growing attention and guiding frameworks, we still know very little about how environmental exposures may be contributing to the health inequities experienced by sexual and gender minority (SGM) people, especially exposures beyond psycho-behavioral mechanisms that have traditionally been viewed as the pathways between minority stress and negative health outcomes. To address this gap in knowledge, we conducted a scoping review to determine the extent to which disparities in environmental exposures between SGM and non-SGM (ie, heterosexual and cisgender) populations have been measured in the United States. We searched PubMed for studies that were (1) peer-reviewed; (2) written in English; (3) quantitatively measured environmental exposures; (4) included 1 or more groups identifying as a sexual minority, gender minority, or both; (5) compared to the general population; (6) in the United States; and (7) published on or after January 1, 2011. Our scoping review identified very few studies that examined and documented environmental exposure disparities between SGM and non-SGM populations in the United States. These studies focused mostly on cigarette smoke exposures. None examined environmental exposure disparities between gender minority and cisgender populations. To address this critical gap in environmental health research for SGM populations in the short term, researchers can merge existing environmental data (eg, data from the Environmental Protection Agency) with SGM population data. Longer-term solutions require systematically including validated sexual orientation and gender identity measures across federal, state, and local datasets, as well as increased funding for original research that explores diverse environmental exposures. Taken together, these efforts can significantly advance our ability to identify and address environmental health inequities experienced by SGM people. Plain language summary: This review looks at how different environmental factors affect the health of sexual and gender minority (SGM) communities, which include people who identify as LGBTQ+. The study found that there is not much research available on this topic, and what exists focuses mostly on cigarette smoke exposure. The review suggests that more research is needed to understand these health disparities and to develop policies that can help protect the health of LGBTQ+ communities. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate whether adolescents from sexual minorities who initiated pre-exposure prophylaxis (PrEP) in community-based organizations (COs) are more socially and HIV-vulnerable compared with their counterparts from a conventional health service. In addition, to evaluate whether these adolescents had more timely access to prophylaxis. METHODS: A PrEP demonstration study was conducted in the city of São Paulo in two COs, located in the center (CO-center) and the outskirts (CO-outskirts), and a conventional HIV testing service (CTA-center). Between 2020 and 2022, cisgender male adolescents who have sex with men (aMSM), transgender and gender diverse adolescents (aTTrans) aged 15 to 19 years, HIV-negative, with higher-risk practices for HIV were eligible for PrEP. Indicators of timely access and vulnerabilities of adolescents initiating PrEP in COs were analyzed using CTA-center as a reference and multinomial logistic regression. RESULTS: 608 adolescents initiated PrEP in COs and CTA-center. Adolescents from COs were associated with a shorter time to PrEP initiation (1-7 days; CO-outskirts: ORa = 2.91; 95%CI 1.22-6.92; CO-center: ORa = 1.91; 95%CI 1.10-3.31); and a lower housing Human Development Index (HDI) (CO-center: ORa = 0.97; 95%CI 0.94-1.00; CO-outskirts: ORa = 0.82; 95%CI 0.78¬0.86). In CO-outskirts, there was an increased chance of adolescents being younger (ORa = 3.06; 95%CI 1.63-5.75) and living closer to the service (ORa = 0.82; 95%CI 0.78-0.86, mean 7.8 km). While adolescents from the CO-center were associated with greater prior knowledge of PrEP (ORa = 2.01; 95%CI 1.10-3.91) and high-risk perception (ORa = 2.02; 95%CI 1.18-3.44), adolescents from the COs were not associated with higher-risk sexual practices and situations of vulnerability to HIV. CONCLUSION: The provision of PrEP in the COs facilitated access for vulnerable adolescents and may contribute to reducing inequities. [ABSTRACT FROM AUTHOR]

Decision-making errors such as present bias (PB) can have important consequences for health behaviors, but have been largely studied in the financial domain. We conducted a mixed-method study on PB in the context of ART adherence among clinic-enrolled adults in Uganda (n = 39). Specifically, we quantified PB by asking about preferences between medication available sooner to minimize headaches versus available later to cure headaches. We describe demographic similarities among PB participants and qualitatively explored how participants reflected on their PB (or absence thereof) in the context of health. Participants reporting PB were predominantly male, single/unmarried, older, had higher levels of education and income and more advanced HIV progression. Three common reasons for more present-biased choices provided were: (1) wanting to avoid pain, (2) wanting to return to work, and (3) fear of one's health worsening if s/he did not address their illness immediately. While PB in the financial domain often suggests that poorer individuals are more likely to prefer immediate rewards over their wealthier counterparts, our results suggest poor health is potentially a driving factor of PB. Further research is needed to build on these finding and inform how programs can frame key messages regarding ART adherence to patients displaying PB. Trial registration: ClinicalTrials.gov identifier: NCT03494777. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether rural‐urban differences in quality of care for Medicare Advantage (MA) enrollees vary between females and males. Methods: Data for this study came from the 2019 Healthcare Effectiveness Data and Information Set. Linear regression was used to investigate urban‐rural differences in individual MA enrollee scores on 34 clinical care measures grouped into 7 categories, and how those differences varied by sex (through evaluation of statistical interactions). Findings: Across all 7 categories of measures, scores for rural residents were worse than scores for urban residents. For 4 categories—care for patients with (suspected) chronic obstructive pulmonary disease, avoiding prescription misuse, behavioral health, and diabetes care—the average difference across measures in the category was greater than 3 percentage points. Across all 34 measures, there were 15 statistically significant rural‐by‐sex interactions that exceeded 1 percentage point. In 11 of those cases, the deficit associated with living in a rural area was greater for males than for females. In 3 cases, the deficit associated with living in a rural area was larger for females than for males. In 1 case involving Follow‐up After Hospitalization for Mental Illness, rural residents had an advantage, and it was larger for males than for females. Conclusions: Interventions may help address patient‐ (eg, health literacy and patient activation), provider‐ (eg, workforce recruitment and retention), and structural‐level issues contributing to these disparities, especially for rural males. [ABSTRACT FROM AUTHOR]