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Young people between the ages of 13 to 24 are at persistent risk for HIV infection in the United States (Centers for Disease Control and Prevention [CDC], 2006). Young adulthood is a period characterized by experimentation, including engagement in risky behaviors (e.g., substance use and sexual behavior) (Moore Sc Parsons, 2000). Most young adults are sexually active, with the highest rates of sexual activity reported among youth of color (Park, Mulye, Adams, Brindis, & Irwin, 2006). The prevalence of sexually transmitted infections (STIs), especially chlamydia and gonorrhea, peak in young adulthood and are highest among youth of color (CDC, 2003). [ABSTRACT FROM AUTHOR]

AIMS: To examine the social triggers of sexual compulsivity amongst a diverse sample of gay and bisexual men. DESIGN AND PARTICIPANTS: Qualitative interviews were conducted with 180 gay and bisexual men in the United States who self-identified that their sex lives were spinning out of control. The data were analyzed using a grounded theory approach to explore the range of social triggers that were driving sexual compulsions. MEASUREMENT: An open-ended interview and a structured clinical interview were conducted with each participant. The interviews examined their experiences with sexual compulsivity over time and the impact of their problematic sexual behaviors on their lives. FINDINGS: Two types of social triggers emerged from the data: event-centered triggers and contextual triggers. Event-centered triggers arise from sudden, unforeseen events. Two major event-centered triggers were identified: relationship turmoil and catastrophes. Contextual triggers, on the other hand, have a certain element of predictability, and included such things as location, people, the use of drugs, and pornography. CONCLUSIONS: This framework of triggers has clinical implications for the prevention and treatment of sexual compulsivity. Clinicians can utilize the framework of social triggers in the therapeutic process to provide insight into ways to effectively work through symptoms of sexual compulsivity. Awareness of the contextual aspects of sexual compulsivity may be critical to understanding the behaviors of sexually compulsive clients. Thus, therapeutic assessments should focus upon the social context in addition to the psychological components of the disorder. [ABSTRACT FROM AUTHOR]

We developed an adherence counseling program to help HIV-positive, opioid dependent patients, receiving primary care in methadone clinics, to improve adherence to highly active antiretroviral therapy (HAART). The intervention is conducted by paraprofessional adherence counselors and consists of six, semi-structured counseling sessions that focus on motivational interviewing and cognitive-behavioral skills training. To date, we have enrolled 119 patients into adherence counseling, suggesting that patients are interested and receptive to the program. Clinic staff has welcomed the additional support provided by the program, and are working collaboratively with the adherence counselors to provide integrated and comprehensive care. The successful implementation of the adherence counseling program indicates that paraprofessionals can effectively be trained to provide semi-structured adherence counseling and that adherence interventions can be incorporated into existing substance abuse and HIV-related treatment programs. [ABSTRACT FROM AUTHOR]

This study reports the results of 337 lesbian and 59 bisexual women who completed a survey of sexual and health behaviors collected at gay, lesbian, and bisexual community events in New York City and Los Angeles. The Stress Related Growth Scale was adapted to capture the unique experience of managing a gay or bisexual identity. Stress related growth (SRG) was positively correlated with age, ethnic community attachment, number of female partners, generativity, and number of years out to self. Women with higher levels of education and women of color scored significantly higher on SRG. Findings indicate that SRG may be more salient when used to explore inherent personal characteristics such as sexual orientation or minority status than general stressful life events. [ABSTRACT FROM AUTHOR]

Crystal methamphetamine (aka 'crystal meth') use with high-risk sex has become an emerging health problem for gay and bisexual men in New York City since the late 1990s. Public health campaigns were eventually developed to encourage gay and bisexual men to avoid or reconsider using crystal meth. Reactions to three campaigns were measured with a cross-sectional survey administered in 2004. Among an ethnically-diverse sample of 971 gay and bisexual men, 61.8% reported seeing the campaigns. Those who reported ever using crystal meth, recent use, and recent use with sex were significantly more likely to have seen the campaigns. In general, white men, HIV-negative men, and men not currently using crystal meth responded more positively to the campaigns than their counterparts; yet, more men of color reported having discussions with partners and friends about their crystal use as a result of these campaigns. Implications for researchers and practitioners are discussed. [ABSTRACT FROM AUTHOR]

The current research aimed to better understand the preventive health behaviors of lesbian and bisexually identified women. We recruited lesbian and bisexual women at a large-scale Gay, Lesbian, and Bisexual (GLB) event in New York City. An ethnically diverse sample of 102 lesbian and 23 bisexually identified women who had sex with women from the New York City metropolitan area completed a quantitative survey. Lesbians, compared to bisexual women, were significantly older and significantly more likely to report being in partnered relationships. Lesbians were also more likely than bisexual women to report having performed recent breast self-examinations. Because of previously inconsistent findings and methodologies, further research is needed to determine the specific effects of lesbian or bisexual identity on preventive health behaviors. doi:10.1300/J013v44n02_01. [ABSTRACT FROM AUTHOR]

A convenience sample of young adults (ages 18-25) in New York City was recruited to complete anonymous surveys in social venues (either dance clubs or other social settings, such as coffee shops and university 'hangouts') regarding their use of 'club drugs' (e.g., MDMA/Ecstasy, GHB, ketamine, crystal methamphetamine, cocaine, and LSD). Participants indicated their frequency of use for each drug and whether or not they had used each drug for the first time in the past six months. A total of 566 surveys were collected and 38.9% of participants reported the use of at least one club drug. Overall, males were significantly more likely than females to report club drug use. There were some differences in club drug use based on sexual orientation, comparing heterosexually identified youth to gay/bisexually identified youth. There were no differences in use among those recruited at dance clubs compared with those recruited from other social venues. The use of club drugs is a growing problem among young adults, as evidenced by the number of participants reporting having tried club drugs for the first time in the past six months. Educational interventions, particularly those designed to reach young adults who are just initiating the use of club drugs, are needed. [ABSTRACT FROM AUTHOR]

Stigma surrounding HIV/AIDS has existed since the beginning of the epidemic, but little is known about HIV/AIDS stigma within the gay community and how it affects men who have sex with men (MSM) living with HIV. A better understanding of the effects of stigma on this population is needed to reduce it and its harmful effects. Our study used quantitative data from 206 HIV-positive MSM and qualitative data from 250 to document beliefs about HIV/AIDS stigma within the gay community and to measure its effects on sexual risk behaviors, substance use behaviors, serostatus disclosure, and mental health. Stigma was associated with increased levels of anxiety, loneliness, depressive symptoms, engaging in avoidant coping strategies, and history of suicidal ideation. HIV/AIDS stigma exists within the gay community and has a negative effect on the mental health of people living with HIV. HIV/AIDS stigma should be monitored closely so that we may better understand how to address it. [ABSTRACT FROM AUTHOR]

This exploratory investigation examined the relationship between childhood sexual abuse (CSA) and related psychosocial characteristics and sexual behaviors among 46 gay/bisexual male escorts who advertise via the Internet. More than a quarter of men (28.3%) reported some history of CSA. Men reporting CSA were more likely to be from an ethnic minority group, identify as bisexual, have a primary male partner, and were less likely to identify an anal receptive ('bottom') sexual role preference. Men with a history of CSA were more likely to report unprotected sex with work-related partners, increased internalized homophobia, and decreased adolescent isolation. Interventions designed for male escorts with a history of CSA should emphasize safer sex strategies with work partners and reducing internalized homophobia. [ABSTRACT FROM AUTHOR]

OBJECTIVES: For HIV-positive injection drug users (IDUs), access to appropriate HIV care is crucial. Providing care for HIV-positive IDUs, however, is often demanding and can be problematic. The health care needs and experiences of IDUs have often been overlooked when efforts to improve HIV care are addressed. METHODS: This study examined health care experiences in a sample of HIV-positive IDUs. A qualitative study of 161 sexually active and currently injecting HIV-positive IDUs from two urban areas was conducted to understand how HIV had affected their lives. Interview data were analyzed using a content analysis approach. RESULTS: Participants' experiences included interactions with health care providers that were both negative and positive experiences. Some HIV-positive IDUs left care because of unfair and discriminatory treatment from providers. CONCLUSIONS: Increasing understanding among providers working with different populations of HIV-positive individuals may positively influence clinical practice and improve the quality of health care for HIV-positive IDU. [ABSTRACT FROM AUTHOR]

The growing research on male commercial sex work has primarily concentrated on adolescent hustlers and street-based workers. Few studies have addressed the specific characteristics of adult male gay or bisexually identified escorts who work independently. We explored qualitatively reasons for and effects of sex work among 46 gay and bisexual male escorts in New York City who use the Internet to advertise their services. Participants completed quantitative measures and a semi-structured qualitative interview. A manual search of themes in the transcribed interviews identified three main reasons for participation in sex work-monetary benefits, positive impact on the self, and sexual pleasure. Participants also reported various changes to their personality and sexuality because of their involvement in commercial sex work. Internet-based male escorts represent a unique population of commercial sex workers, different from male sex workers who work on the streets, and have their own specific health needs. [ABSTRACT FROM AUTHOR]

Relatively little attention has been paid to unique factors that may motivate HIV-seropositive men who have sex with men (MSM) to prevent HIV transmission. This study examines the beliefs of 250 HIV-seropositive MSM about their responsibility for protecting sex partners from HIV infection. Participants completed an open-ended interview about their sexual practices, substance use, and other HIV-related issues. Seventy percent of participants were men of color. Most participants (72%) spontaneously mentioned issues related to responsibility that were represented by three themes: (1) personal responsibility for protecting sex partners, (2) partners' responsibility for protecting themselves, and (3) mutual responsibility. These beliefs were expressed by 63%, 24%, and 12% of respondents, respectively. Motivations underlying beliefs about personal responsibility included altruism, self-standards, and self-interest. Beliefs about personal responsibility were influenced by participant characteristics, partner characteristics, disclosure of HIV status, and contextual factors. The findings suggest that self-perceived responsibility may be an important factor that affects HIV-seropositive MSM's sexual decision making. [ABSTRACT FROM AUTHOR]

Determinants of safer sexual behaviors (abstinence or consistent condom use) among female partners of HIV-infected adult men with hemophilia were examined. A model was proposed predicting that emotional adjustment, communication skills, self-efficacy, and perceived advantages of condom use would influence the practice of safer sexual behaviors. Confidential surveys were completed by 119 seronegative female partners of men with hemophilia and HIV infection who received care from one of 27 hemophilia treatment centers across the United States. The proposed model was tested using LISREL, and the model explained 40% of the variance in safer sexual behaviors. Emotional adjustment was a significant predictor of both intimate and emotional communication skills. Intimate and emotional communication skills were related to self-efficacy for communicating about safer sex, which in turn influenced both communication about safer sex and perceived advantages of condom use. Communication about safer sex with a partner and perceived advantages of condom use had direct effects on safer sexual behaviors. HIV prevention interventions with women known to have seropositive partners should be multifaceted. Skill-building interventions emphasizing communication skills, increasing self-efficacy for communication about safer sex with a partner, and promoting positive attitudes about safer sex should be considered. [ABSTRACT FROM AUTHOR]

Objectives. We sought to determine whether field outreach with motivational interviewing, as compared with traditional field outreach, leads to increases in HIV counseling and testing and rates of return for test results among young African American men who have sex with men (MSM). Methods. In a randomized, 2-group, repeated-measures design, 96 young African American MSM completed a motivational interviewing-based field outreach session and 92 young African American MSM completed a traditional field outreach session. The percentages of participants agreeing to traditional HIV counseling and testing (an oral swab of the cheek) and returning for test results were the primary outcome measures. Results. More of the participants in the motivational interviewing condition than the control condition received HIV counseling and testing (49% versus 20%; {chi}21 = 17.94; P = .000) and returned for test results (98% versus 72%; {chi}21 = 10.22; P = .001). Conclusions. The addition of motivational interviewing to field outreach is effective in encouraging high-risk young African American MSM to learn their HIV status. Also, peer outreach workers can be effectively trained to reduce health disparities by providing evidence-based brief counseling approaches targeting high-risk minority populations. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To provide an overview of clinical outcomes assessment, discuss the classification of outcomes measures, present considerations for choosing outcomes scales, identify the importance of assessing clinical outcomes, and describe the critical link between the utilization of disablement models and clinical outcomes assessment. BACKGROUND: Clinical outcomes are the end result of health care services. Clinical outcomes assessment is based on the conceptual framework of disablement models and serves as the measurement method for the collection of patient-oriented evidence, a concept central to evidence-based practice. DESCRIPTION: Clinical outcomes management refers to the use of outcomes measures in the course of routine clinical care and provides athletic trainers with a mechanism to assess treatment progress and to measure the end results of the services they provide. Outcomes measures can be classified as either clinician based or patient based. Clinician-based measures, such as range of motion and strength, are taken directly by clinicians. Patient-based measures solicit a patient's perception as to health status in the form of questionnaires and survey scales. Clinician-based measures may assist with patient evaluation, but patient-based measures should always be included in clinical assessment to identify what is important to the patient. CLINICAL AND RESEARCH ADVANTAGES: Evidence-based athletic training practice depends on clinical outcomes research to provide the foundation of patient-oriented evidence. The widespread use of clinical outcomes assessment, based on the disablement model framework, will be necessary for athletic trainers to demonstrate the effectiveness of therapies and interventions, the provision of patient-centered care, and the development of evidence-based practice guidelines. [ABSTRACT FROM AUTHOR]

Existing research has demonstrated the significance of situational antecedents to substance use. The current study used a cluster analytic approach to identify groups of club drug users who report using substances in similar situations (assessed by the Inventory of Drug Taking Situations) with longitudinal data from 400 active drug users. A three-cluster solution emerged in baseline data and was replicated in 12-month follow-up data. Groups were identified as Situationally Restricted, Pleasure Driven, and Situationally Broad users. Group differences were observed on measures of mental health, attitudes towards substance use, amount of substance use, and rates of substance dependence. Cluster membership predicted substance dependence after controlling for past dependence, current use, and current depression/anxiety. [ABSTRACT FROM AUTHOR]

Objective: This study investigates HIV positive adolescents' health literacy and whether factors associated with health literacy in HIV-positive adults are associated with health literacy among HIV-positive adolescents.Methods: Adolescents in this study were behaviorally and perinatally HIV-infected youth (n=186) from five U.S. cities. Participants had a mean age of 20.5, and 49.5% were male.Results and Conclusions: Contrary to findings for adult HIV-positive patients, among adolescents health literacy was not significantly associated with: medication adherence adjusting for age and education level; viral load; or self-efficacy to adhere to medication regimens. The only significant association was of health literacy with medical care received.Practice Implications: Practice implications are discussed. [ABSTRACT FROM AUTHOR]

Reported rates of recreational drug use among gay and bisexual men are currently rising. Although there has been much empirical research documenting current trends in drug use among gay and bisexual men, little research has empirically contrasted differential rates across urban epicenters, while even less has addressed racial or ethnic variation (between and within cities). This knowledge is essential both for the development of effective culturally-sensitive health education prevention/services and for understanding drug use prevalence among urban epicenters. Using the men's data gathered from large-scale gay, lesbian, and bisexual (GLB) community events in New York and Los Angeles in the fall of 2003 and spring of 2004 (N = 2,335), this study explored racial and ethnic variance in the use of methamphetamine, cocaine, MDMA/ecstacy (methylenedioxy-methamphetamine), ketamine, GHB (gamma-hydroxy-butyrate), marijuana, and nitrate inhalants (poppers) among gay and bisexual men both between and within cities (NYC and LA). Levels of recent drug use were fairly consistent between New York City and Los Angeles; however there was some between and within city racial and ethnic variance. In particular, Asian/Pacific Islander men were among those least likely to report use of some drugs. Findings suggest substance use in the gay community permeates geographic boundaries in addition to some racial and ethnic boundaries such that interventions targeting drug-using gay and bisexual men should appropriately attend to racial and ethnic diversity within communities. [ABSTRACT FROM AUTHOR]

Background: Sexual and gender minority (SGM) young people are disproportionately affected by HIV in the United States, and substance use is a major driver of new infections. People who use web-based venues to meet sex partners are more likely to report substance use, sexual risk behaviors, and sexually transmitted infections. To our knowledge, no machine learning (ML) interventions have been developed that use web-based and digital technologies to inform and personalize HIV and substance use prevention efforts for SGM young people., Objective: This study aims to test the acceptability, appropriateness, and feasibility of the uTECH intervention, a SMS text messaging intervention using an ML algorithm to promote HIV prevention and substance use harm reduction among SGM people aged 18 to 29 years who have sex with men. This intervention will be compared to the Young Men's Health Project (YMHP) alone, an existing Centers for Disease Control and Prevention best evidence intervention for young SGM people, which consists of 4 motivational interviewing-based counseling sessions. The YMHP condition will receive YMHP sessions and will be compared to the uTECH+YMHP condition, which includes YMHP sessions as well as uTECH SMS text messages., Methods: In a study funded by the National Institutes of Health, we will recruit and enroll SGM participants (aged 18-29 years) in the United States (N=330) to participate in a 12-month, 2-arm randomized comparison trial. All participants will receive 4 counseling sessions conducted over Zoom (Zoom Video Communications, Inc) with a master's-level social worker. Participants in the uTECH+YMHP condition will receive curated SMS text messages informed by an ML algorithm that seek to promote HIV and substance use risk reduction strategies as well as undergoing YMHP counseling. We hypothesize that the uTECH+YMHP intervention will be considered acceptable, appropriate, and feasible to most participants. We also hypothesize that participants in the combined condition will experience enhanced and more durable reductions in substance use and sexual risk behaviors compared to participants receiving YMHP alone. Appropriate statistical methods, models, and procedures will be selected to evaluate primary hypotheses and behavioral health outcomes in both intervention conditions using an α<.05 significance level, including comparison tests, tests of fixed effects, and growth curve modeling., Results: This study was funded in August 2019. As of June 2024, all participants have been enrolled. Data analysis has commenced, and expected results will be published in the fall of 2025., Conclusions: This study aims to develop and test the acceptability, appropriateness, and feasibility of uTECH, a novel approach to reduce HIV risk and substance use among SGM young adults., Trial Registration: ClinicalTrials.gov NCT04710901; https://clinicaltrials.gov/study/NCT04710901., International Registered Report Identifier (irrid): DERR1-10.2196/58448., (©Ian W Holloway, Elizabeth S C Wu, Callisto Boka, Nina Young, Chenglin Hong, Kimberly Fuentes, Kimmo Kärkkäinen, Mehrab Beikzadeh, Alexandra Avendaño, Juan C Jauregui, Aileen Zhang, Lalaine Sevillano, Colin Fyfe, Cal D Brisbin, Raiza M Beltran, Luisita Cordero, Jeffrey T Parsons, Majid Sarrafzadeh. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 20.08.2024.)

Background: Little attention has been given to efficacious treatment and adherence to treatment of compulsive sexual behavior (CSB)., Aims: Randomized controlled trial investigated short-term psychodynamic group therapy followed by relapse prevention group (STPGP-RPGT) and pharmacological treatment (PT) for CSB men on sexual compulsivity and adherence., Method: 135 men, 38 (SD = 9) years old on average, were randomly assigned to 1) STPGP-RPGT; 2) PT; 3) Both. Participants completed measures at baseline, 25th, and 34th week. 57 (42.2%) participants dropped out between baseline and 25th week, and 68 (50.4%) between baseline and 34th week. 94 (69.6%) did not adhere (80% pills taken or attended 75% therapy sessions)., Results: A significant interaction effect was found between time and group (F (4, 128) = 2.62, P = 0.038, ES = 0.08), showing who received PT improved less in sexual compulsivity than those who received STPGP-RPGT (t = 2.41; P = 0.038; ES = 0.60) and PT + STPGP-RPGT (t = 3.15; P = 0.007, ES = 0.74). Adherent participants improved more in sexual compulsivity than non-adherent at the 25th week (t = 2.82; P = 0.006, ES = 0.65) and 34th week (t = 2.26; P = 0.027, ES = 0.55), but there was no interaction effect, F (2, 130) = 2.88; P = 0.06; ES = 0.04). The most reported behavior (masturbation) showed greater risk of non-adherence (72.6%)., Discussion and Conclusions: Adherent participants improved better than non-adherent. Participants who received psychotherapy improved better than those who received PT. Methodological limitations preclude conclusions on efficacy.

Although transgender women (TGW), and especially TGW of color, are disproportionately exposed to discrimination and violence, many of them experience stress-related growth. However, little is known about the experience of stress-related growth and its correlates among TGW. Using data from a racially-diverse sample of 210 TGW, the short version of the Stress-Related Growth Scale was modified to assess growth as a result of coming to terms with one's transgender identity among TGW. The psychometric properties of the modified scale were examined, along with its associations with various cognitive, emotional, and social factors. A confirmatory factor analysis revealed a unidimensional factor, along with excellent reliability. A stepwise regression revealed that positive reappraisal, internal locus of control, social support, and emotional expression were associated with greater stress-related growth. Findings suggest that cognitive, emotional, and social resources are related to stress-related growth in TGW. Interventions to foster stress-related growth among TGW are discussed.

Despite the prominence of self-efficacy as a predictor of antiretroviral therapy (ART) adherence, relatively little work has examined domain-specific associations with steps in the care continuum or the possibility that substance use may have domain-specific associations with self-efficacy. This study analyzed data from a sample of 174 people living with HIV recruited through three clinics in the New York City metro area. Consistent with hypotheses, path analysis showed that appointments kept and viral load were each predicted only by their respective domain-specific self-efficacy components (i.e., self-efficacy for keeping appointments, B  = 0.01, p  = .04; and self-efficacy for taking ART medications, B  = -0.02, p  < .01). Path models also indicated domain-specific associations with substance use. Self-efficacy for keeping appointments was negatively associated with severity of drug use ( B  = -1.81, p  < .01); meanwhile, self-efficacy for taking ART medications was negatively associated with severity of alcohol use ( B  = -0.52, p  < .01). Accordingly, studies assessing barriers to retention in the HIV care continuum should conduct multi-domain assessments of self-efficacy for differential associations with specific behaviors. Furthermore, HIV care providers might consider screening for domain-specific self-efficacy to identify patients at risk of drop-out and tailoring interventions to various care continuum domains.

This study evaluated the effectiveness of Project PLUS, a 6-session Motivational Interviewing and Cognitive Behavioral intervention to reduce substance use and improve antiretroviral therapy (ART) adherence among PLWH. In a quasi-experimental design, 84 participants from a network of three comprehensive care clinics in New York City received the intervention immediately post-baseline (the Immediate condition) and 90 were assigned to a Waitlist control. Viral load and CD4 data were extracted from electronic medical records (EMR) for a No-Intervention comparison cohort (n = 120). Latent growth curve analyses did not show a consistent pattern of significant between-group differences post-intervention or across time in ART adherence or substance use severity between Immediate and Waitlist participants. Additionally, Immediate intervention participants did not differ significantly from the Waitlist or No-Treatment groups on viral load or CD4 post-intervention or across time. The potential to detect intervention effects may have been limited by the use of a quasi-experimental design, the high quality of standard care at these clinics, or inadequate intervention dose.Trial Registration: ClinicalTrials.gov (NIH U.S. National Library of Medicine) Identifier: NCT02390908; https://clinicaltrials.gov/ct2/show/NCT02390908., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Perfluorocarbon emulsions (PFCs) are intravenous artificial oxygen carriers with enhanced gas solubility. As lipid micelle nanoparticle emulsions, PFCs may have a class effect that causes degrees of thrombocytopenia. Understanding the extent of the platelet effects, including mechanism and potential inflammation after PFC infusion, is important for safe human trials., Methods: Normal sheep (Dorper) were infused with 5 mL/kg of Oxygent (w/v 60% PFC) or Perftoran (w/v 20% PFC). Controls received 6% Hetastarch or were naive. Blood samples were analyzed from baseline, time 0 (the end of infusion), 3 and 24 hours, and 4 and 7 days. Platelet count, plateletcrit, mean platelet volume, platelet distribution width, and CD-62p (a platelet activation-dependent membrane protein) were measured. Neutrophils, monocytes, and total white blood cell counts were analyzed., Results: In these inflammatory cell lines, there were no consistent changes or cellular activation after PFC infusion. A decrease (<10% from baseline and naive controls) in platelet count was seen on day 4 after Oxygent infusion (3 g/kg), which recovered by day 7. No platelet effect was seen in Perftoran (1 g/kg). Plateletcrit, mean platelet volume, and platelet distribution width did not change significantly at any time point among the groups. CD-62p, ADP, and collagen aggregometry showed no significant change in platelet function., Conclusion: There was no evidence of overall reduction in platelet number, or any correlation with the change in platelet activation or inhibition. Therefore, the risk of increased thrombosis/bleeding after PFC intravenous infusion is low in this non-trauma sheep model., (Copyright © 2021. Published by Elsevier Inc.)

Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are highly efficacious biomedical prevention strategies, which significantly reduce the risk of HIV transmission. Yet, partnered sexual minority men (SMM) continue to exhibit poorer uptake rates especially those in a non-monogamous or serodiscordant relationship for whom PrEP is recommended. The purpose of the study was to identify factors that may facilitate or impede the uptake of PrEP or PEP among partnered SMM. This qualitative study conducted semi-structured interviews with 10 sexual minority male couples recruited from the New York City metropolitan area. Thematic analysis identified relationship-specific and structural-level factors, which influence motivation and willingness for biomedical prevention uptake. Specifically, results highlighted the tension between relationship functioning and HIV prevention. In addition, stigma and access to knowledgeable health care providers diminished interest in biomedical prevention. Findings suggest a need for interventions that frame biomedical prevention in ways that minimize social perceptions of mistrust between partners and improve access.

Despite being grouped together in epidemiological risk categories, gay, bisexual, and other men who have sex with men (GBM) are not a homogenous group. In addition to traditional segmentation along race, ethnicity, and socioeconomic status, many GBM also identify with sexual subcultural communities. Previous research has shown differences across a variety of health outcomes between these sexual subcultural communities. The purpose of this study was to determine whether HIV prevention practices among GBM differed according to sexual subcultural community. The study was conducted in collaboration with a popular social and sexual networking smartphone application company. A total of 23,577 GBM responded to the survey. A latent class analysis identified 6 distinct classes related to sexual subcultural community identification. We found significant differences across sociodemographic characteristics, HIV prevention practices, and condomless anal sex in the past 6 months related to sexual subculture identification. Findings suggest that sexual subcultural identity is related to decision-making around HIV prevention among GBM. Differences in HIV prevention strategies are likely a function of group norms, unique shared experiences among GBM identifying with a particular sexual subculture community, and sociodemographic characteristics associated with these groups. As such, sexual subculture identity should be considered in developing interventions and social marketing campaigns to increase uptake of biomedical HIV prevention tools among GBM. Identifying group norms and shared experiences related to HIV prevention practices among sexual subcultures is necessary to understand the role these identities play in lives of GBM, especially as it relates to their sexual health and well-being.

Youth represent 21% of new HIV diagnoses in the United States. Gay, bisexual, and transgender (GBT) youth, particularly those from communities of color, and youth who are homeless, incarcerated, in institutional settings, or engaging in transactional sex are most greatly impacted. Compared with adults, youth have lower levels of HIV serostatus awareness, uptake of antiretroviral therapy (ART), and adherence. Widespread availability of ART has revolutionized prevention and treatment for both youth at high risk for HIV acquisition and youth living with HIV, increasing the need to integrate behavioral interventions with biomedical strategies. The investigators of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) completed a research prioritization process in 2019, focusing on research gaps to be addressed to effectively control HIV spread among American youth. The investigators prioritized research in the following areas: (1) innovative interventions for youth to increase screening, uptake, engagement, and retention in HIV prevention (eg, pre-exposure prophylaxis) and treatment services; (2) structural changes in health systems to facilitate routine delivery of HIV services; (3) biomedical strategies to increase ART impact, prevent HIV transmission, and cure HIV; (4) mobile technologies to reduce implementation costs and increase acceptability of HIV interventions; and (5) data-informed policies to reduce HIV-related disparities and increase support and services for GBT youth and youth living with HIV. ATN's research priorities provide a roadmap for addressing the HIV epidemic among youth. To reach this goal, researchers, policy makers, and health care providers must work together to develop, test, and disseminate novel biobehavioral interventions for youth., (©M Isabel Fernandez, Gary W Harper, Lisa B Hightow-Weidman, Bill G Kapogiannis, Kenneth H Mayer, Jeffrey T Parsons, Mary Jane Rotheram-Borus, Arlene C Seña, Patrick S Sullivan. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 04.01.2021.)

Little is known about how to best implement eHealth HIV interventions for adolescent men who have sex with men (AMSM) in real-world settings. In response, our current study describes formative implementation research with community-based organizations (CBOs) in preparation for future implementation of the SMART Program, a stepped-care package of three interventions adapted for AMSM. In-depth interviews focusing on eHealth implementation were conducted with a convenience sample of 12 stakeholders from nine CBOs that actively implemented sexual-minority-focused HIV/AIDS prevention programs. Qualitative analysis was conducted using Dedoose to identify salient themes. Most programs implemented at the CBOs engaged adult MSM for HIV prevention, but CBOs reported less experience with outreach of AMSM for HIV prevention. While comfortable with and skilled at implementing traditional in-person HIV prevention programs, interviewees reported that eHealth programs fell outside of their organizations' technical capacities. They suggested specific strategies to facilitate successful implementation of SMART and other eHealth programs, including technical-capacity-building at CBOs, better training of staff, and partnering with a national coordinating center that provides support for the technology. Overall, the CBOs reported enthusiasm for the SMART Program and thought it an efficient way to bridge their current gaps in online programming and lack of AMSM HIV prevention strategies., Competing Interests: Declaration of Conflicting Interest: The authors declare that there is no conflict of interest. Conflicts of Interest: The authors declare that they have no conflicts of interest.

Importance: Youth living with HIV make up one-quarter of new infections and have high rates of risk behaviors but are significantly understudied. Effectiveness trials in real-world settings are needed to inform program delivery., Objective: To compare the effectiveness of the Healthy Choices intervention delivered in a home or community setting vs a medical clinic., Design, Setting, and Participants: This randomized clinical trial was conducted from November 1, 2014, to January 31, 2018, with 52 weeks of follow-up. Participants, recruited from 5 adolescent HIV clinics in the United States, were youths and young adults living with HIV aged 16 to 24 years who were fluent in English, were currently prescribed HIV medication, had a detectable viral load, and had used alcohol in the past 12 weeks. Individuals with an active psychosis that resulted in an inability to complete questionnaires were excluded. Data were analyzed from May to December, 2019., Interventions: Participants were randomized to receive the Healthy Choices intervention in either a home or clinic setting. Four 30-minute individual sessions based on motivational interviewing to improve (1) medication adherence and (2) drinking behavior were delivered during 10 weeks by trained community health workers. In session 1, participants chose which behavior to discuss first. Using motivational interviewing strategies, the community health worker elicited motivational language, guided the development of an individualized change plan while supporting autonomy, delivered feedback, and addressed knowledge gaps. Session 2 focused on the second target behavior. In subsequent sessions, community health workers reviewed the individualized change plan, monitored progress, guided problem solving, and helped maintain changes made., Main Outcomes and Measures: Primary outcomes were viral load and alcohol use change trajectories during 52 weeks of follow-up. Alcohol use severity and frequency were measured using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) (scores range from 0 to 33, with higher scores indicating greater severity of alcohol-related problems) and number of drinks consumed each day over a 30-day period, with timeline followback., Results: A total of 183 young people living with HIV (145 male [79.2%]; mean [SD] age, 21.4 [1.9] y) were randomized to the home setting (n = 90) or clinical setting (n = 93). Using growth-curve analysis, both groups showed declines in viral load after the intervention: among participants with available viral load information, in the home group, 12 participants (21%) had an undetectable viral load at 16 weeks, 12 (22%) at 28 weeks, and 10 (20%) at 52 weeks; in the clinic group, 16 participants (24%) had an undetectable viral load at 16 weeks, 20 (39%) at 28 weeks, and 18 (35%) at 52 weeks. However, the clinic group maintained gains, whereas those counseled at home had a significantly different and increasing trajectory during follow-up (unstandardized β = -0.07; 95% CI,-0.14 to -0.01; P = .02). A similar pattern was observed in ASSIST scores during follow-up, with reduced ASSIST scores in the clinic group (unstandardized β = -0.44; 95% CI,-0.81 to -0.07; P = .02)., Conclusions and Relevance: In this trial, the Healthy Choices intervention resulted in improvements in viral load and alcohol use over 12 months. Unexpectedly, the clinic setting outperformed home-based delivery for viral suppression. Although cross-sectional differences in ASSIST scores were nonsignificant, clinic delivery did improve the trajectory of ASSIST scores during follow-up. Thus, clinics may be the more effective site for interventions aimed at viral load reduction for young people living with HIV., Trial Registration: ClinicalTrials.gov Identifier: NCT01969461.

Purpose: By 2020, 70% of people living with HIV in the United States will be greater than 50 years of age. As many as 37% of sexually active older people living with HIV (OPLWH) engage in HIV transmission sexual behaviors. In spite of repeated calls for secondary prevention interventions to reduce condomless sex in OPLWH, no age-appropriate, evidence-based secondary prevention interventions exist for this group. Furthermore, many OPLWH face barriers to engaging in face-to-face secondary prevention services because of HIV- and age-related stigma, comorbid mental and physical health conditions that complicate travel, or geographic isolation. High rates of depression in OPLWH may further complicate engagement in interventions intended to reduce HIV transmissions. Telephone-administered motivational interviewing may be a feasible and efficacious intervention for this population., Methods: This randomized controlled trial will test the efficacy of a 5-session telephone-administered motivational interviewing plus behavioral skills training (teleMI+BST) intervention versus a 5-session telephone-administered coping effectiveness training (teleCET) control intervention to reduce condomless sex in OPLWH. A diverse sample of 336 OPLWH will be recruited across the U.S. The primary analysis will test the efficacy of teleMI+BST to reduce occasions of non-condom protected anal and vaginal intercourse with HIV serodiscordant sex partners. Secondary analyses will examine the efficacy of teleMI+BST to reduce depressive symptoms in mildly depressed OPLWH., Conclusion: This is the first large-scale RCT intended to reduce HIV sexual transmission risk behavior in OPLWH and will add to the literature on secondary prevention telehealth interventions for people living with HIV. ClinicalTrials.gov Identifier: NCT03004170. This trial has been conducted by the approval of the Institutional Review Board. Participants provided verbal consent to participate in this trial., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Loss of intracellular calcium homeostasis is an established mechanism associated with neuronal dysfunction and status epilepticus. Sequestration of free cytosolic calcium into endoplasmic reticulum by Mg 2+ /Ca 2+ adenosinetriphosphatase (ATPase) is critical for maintenance of intracellular calcium homeostasis. Exposing hippocampal cultures to low-magnesium media is a well-accepted in vitro model of status epilepticus. Using this model, it was shown that endoplasmic reticulum Ca 2+ uptake was significantly inhibited in homogenates from cultures demonstrating electrophysiological seizure phenotypes. Calcium uptake was mainly neuronal. However, glial Ca 2+ uptake was also significantly inhibited. Viability of neurons exposed to low magnesium was similar to neurons exposed to control solutions. Finally, it was demonstrated that Ca 2+ uptake inhibition and intracellular free Ca 2+ levels increased in parallel with increasing incubation in low magnesium. The results suggest that inhibition of Mg 2+ /Ca 2+ ATPase-mediated endoplasmic reticulum Ca 2+ sequestration contributes to loss of intracellular Ca 2+ homeostasis associated with status epilepticus. This study describes for the first time inhibition of endoplasmic reticulum Mg 2+ /Ca 2+ ATPase in a mixed primary hippocampal model of status epilepticus. In combination with animal models of status epilepticus, the cell culture model provides a powerful tool to further elucidate mechanisms that result in inhibition of Mg 2+ /Ca 2+ ATPase and downstream consequences of decreased enzyme activity.