Faculty Bibliography

Depression among Black transgender women (BTW) in the USA is an often understudied mental health concern with far-reaching consequences for overall physical and mental health at both the individual and community levels. Intimate partner violence (IPV) among BTW is also a frequently understudied and important social determinant of health in need of further exploration. This study sought to address the gap in research on the relationship between IPV and depression among BTW using a time- and location-based community sample of BTW from six US cities. In addition, it sought to explore the potential protective or suppressive effect of perceived social support on this relationship. Generalized structural equation models were used to assess conditional direct and indirect effects of IPV on depression via the suppression effect of perceived social support. Evidence was found of a statistically significant conditional direct effect of IPV on depression as well as a statistically significant suppression effect for perceived social support. Specifically, there was a 20% lower likelihood of increased depressive symptomatology for every 1-unit increase in perceived social support reported by participants. These findings indicated that perceived social support may be an important intervention point for helping to improve the mental health and well-being of BTW.

The religious and spiritual experiences of HIV-positive gay, bisexual, and other men who have sex with men (MSM) are severely understudied, especially among those over 50. However, literature supports that religious/spiritual experiences are related to both physical and mental health among older adults. In this exploratory analysis we assessed the relations that exist among a sample of HIV-positive gay, bisexual, and other MSM over 50 in regard to sociodemographic factors and two established measures of religiosity/spirituality. Differences emerged in relation to both race/ethnicity and age for the Ironson-Woods Spirituality/Religiousness (SR) Index, while, for the Existential Well-being subscale, differences emerged in relation to race/ethnicity and perceived socioeconomic status. © 2013 Taylor & Francis Group, LLC.

HIV disproportionately affects African American men who have sex with men (MSM) in the United States. To inform this epidemiological pattern, we examined cross-sectional sexual behavior data in 509 African American MSM. Bivariate logistic regression analyses were conducted to examine the extent to which age, education, and sexual identity explain the likelihood of engaging in sex with a partner of a specific gender and the likelihood of engaging in unprotected sexual behaviors based on partner gender. Across all partner gender types, unprotected sexual behaviors were more likely to be reported by men with lower education. Younger, non-gay identified men were more likely to engage in unprotected sexual behaviors with transgender partners, while older, non-gay identified men were more likely to engage in unprotected sexual behaviors with women. African American MSM do not represent a monolithic group in their sexual behaviors, highlighting the need to target HIV prevention efforts to different subsets of African American MSM communities as appropriate.

Cross-sectional analyses of 904 diverse men and women aged 50 years and older living with HIV in New York City were conducted to examine the unique experiences and needs of aging HIV-positive individuals. Using Minority Stress Theory and Syndemic Theory as guiding paradigms, the authors documented the mental health burdens of the sample with regard to depression, loneliness, and diminished psychological well-being and examined how multiple-minority status and HIV-related stigma explained these burdens. Mediation modeling demonstrated that the effects of minority stressors on mental health burden were mediated by HIV-related stigma. The mediation was significant for the overall sample and for the male subsample. Results suggest that to fully address the mental health burdens experienced by aging HIV-positive individuals, we must continue to address mental health burdens directly, and at the same time, look beyond the psychiatric symptoms to address the structural inequities faced by individuals based on their multiple-minority status.

The theory of syndemics has been widely applied in HIV prevention studies of gay, bisexual, and other MSM over the last decade. Our investigation is the first to consider the applicability of the theory in a sample of aging (ages 50 and over) HIV-positive MSM, which is a growing population in the United States. A sample of 199 men were actively recruited and assessed in terms of mental health and drug use burden, as well as sexual risk behaviors. Bivariate and multivariable analyses indicate a high level of association between psychosocial burdens (i.e., drug use and mental health) and same-sex unprotected sexual behaviors, providing initial support for the applicability of the theory of syndemics to this population. Further support can be seen in participants' narratives. Findings suggest the mutually reinforcing nature of drug use, psychiatric disorders, and unprotected sexual behavior in older, HIV-positive, gay, bisexual, and other MSM, highlighting the need for holistic strategies to prevention and care among this population of older and sexually active individuals. In short, the generation of gay men who came of age in the late 1970s and 1980s, "the AIDS Generation," are continuing to mature such that further efforts must be enacted to meet the multidimensional nature of these men's physical, mental, and sexual health needs.

BACKGROUND: African American men who have sex with men (MSM) are disproportionately affected by HIV and constitute more than half of all HIV-infected MSM in the USA. PURPOSE: Data from the New York City location of a multi-site study were used to evaluate the effectiveness of three HIV testing strategies for detecting previously undiagnosed, 18 to 64-year-old African American MSM. Effectiveness was defined as the identification of seropositive individuals. METHODS: Using a quasi-experimental design (N = 558), we examined HIV-positive test results for men tested via alternative venue testing, the social networks strategy, and partner counseling and referral services, as well as behavioral risk factors for 509 men tested through alternative venue testing and the social networks strategy. RESULTS: Detection rates of HIV-positives were: alternative venue testing-6.3%, the social networks strategy-19.3%, and partner services-14.3%. The odds for detection of HIV-positive MSM were 3.6 times greater for the social networks strategy and 2.5 times greater for partner services than alternative venue testing. Men tested through alternative venue testing were younger and more likely to be gay-identified than men tested through the social networks strategy. Men who tested through the social networks strategy reported more sexual risk behaviors than men tested through alternative venue testing. CONCLUSIONS: Findings suggest differential effectiveness of testing strategies. Given differences in the individuals accessing testing across strategies, a multi-strategic testing approach may be needed to most fully identify undiagnosed HIV-positive African American MSM

Cross-sectional data were collected on a sample of 259 gay and bisexual, male-identified individuals as part of a larger study of the psychosocial functioning of lesbian, gay, bisexual, and transgender persons. Analyses considered differences between HIV-positive and HIV-negative men in relation to active and religious coping strategies; avoidant coping strategies (specifically, illicit drug use); and the psychosocial states of anxiety, hostility, and depression in relation to self-reported HIV-status of the participants. As compared with HIV-negative men, the HIV positive participants indicated a greater likelihood of engaging in illicit substance use within the previous 3 months, as well as higher levels of both active and religious coping strategies. Illicit substance use also was found to be related to higher levels of depression, anxiety, and hostility. A multivariate model indicated a significant difference in substance-based and active coping strategies among the men surveyed, with persons with a self-reported HIV-positive serostatus endorsing higher levels of both strategies. These results and their implications for prevention and future research are discussed, rooted in the understanding that a complex reality for coping is often enacted by HIV-positive men