Objectives The HIV care cascade provides milestones to track the progress of HIV-positive people from seroconversion through viral suppression. We propose a Motivational PrEP Cascade involving five stages based upon the Transtheoretical Model of Change. Methods We analyzed data from 995 men in One Thousand Strong, a longitudinal study of a national panel of HIV-negative gay and bisexual men in the United States. Results Nearly all (89%) participants were sexually active in the past 3 months, and 65% met CDC criteria for PrEP candidacy. Of those identified as appropriate candidates, 53% were Precontemplative (Stage 1; unwilling to take or believing they were inappropriate candidates for PrEP) and 23% were in Contemplation (Stage 2; willing and self-identified as appropriate candidates). Only 11% were in PrEParation (Stage 3; seeing PrEP as accessible and planning to initiate PrEP) and 4% were in PrEP Action (Stage 4; prescribed PrEP). Although few of those who were identified as appropriate candidates were on PrEP, nearly all PrEP users (98%) reported adhering to 4 or more doses per week and most (72%) were returning for recommended quarterly medical visits, resulting in 9% of PrEP candidates reaching Maintenance and Adherence (Stage 5). Conclusions A large majority of participants were appropriate candidates for PrEP, yet fewer than 1 in 10 were using and adherent to PrEP. These findings highlight the need for interventions tailored to address the unique barriers men face at each stage of the cascade, particularly at the earliest stages where the most dramatic losses were identified.

This paper presents a systematic review of the quantitative HIV research that assessed the relationships between religion, spirituality, HIV syndemics, and individual HIV syndemics-related health conditions (e.g. depression, substance abuse, HIV risk) among men who have sex with men (MSM) in the United States. No quantitative studies were found that assessed the relationships between HIV syndemics, religion, and spirituality. Nine studies, with 13 statistical analyses, were found that examined the relationships between individual HIV syndemics-related health conditions, religion, and spirituality. Among the 13 analyses, religion and spirituality were found to have mixed relationships with HIV syndemics-related health conditions (6 nonsignificant associations; 5 negative associations; 2 positive associations). Given the overall lack of inclusion of religion and spirituality in HIV syndemics research, a conceptual model that hypothesizes the potential interactions of religion and spirituality with HIV syndemics-related health conditions is presented. The implications of the model for MSM’s health are outlined.

The purpose of this study was to determine the associations between religion, spirituality, and mental health among gay and bisexual men (GBM). A U.S. national sample of 1,071 GBM completed an online survey that measured demographic characteristics, religiosity, religious coping, spirituality, and four mental health constructs (i.e., depressive symptoms, rejection sensitivity, resilience, and social support). Linear regressions determined the associations between each mental health construct, demographic variables, and the spirituality and religion variables. Controlling for demographic characteristics, spirituality was negatively associated with depressive symptoms and rejection sensitivity, and positively associated with resilience and social support (all p < .001). Religiosity was positively associated with rejection sensitivity (p < .05) and negatively associated with resilience (p < .01). Religious coping was positively associated with depression (p < .001) and rejection sensitivity (p < .05) and negatively associated with resilience (p < .05) and social support (p < .05). The interaction of spirituality with religiosity was significantly associated with all mental health variables. In general, religious GBM with higher levels of spirituality had better mental health outcomes. Public health interventions and clinical practice aimed at decreasing negative mental health outcomes among GBM may find it beneficial to integrate spirituality into their work.

Religion is one of the most powerful and ubiquitous forces in African American same-gender-loving (SGL) men's lives. Research indicates that it has both positive and negative influences on the health behaviors and outcomes of this population. This paper presents a review of the literature that examines religion as a risk and protective factor for African American SGL men. A strengths-based approach to religion that aims to utilize its protective qualities and weaken its relation to risk is proposed. Finally, recommendations are presented for the use of a strengths-based approach to religion in clinical work and research.