IntroductionMen who have sex with men (MSM) are one of the most at-risk group for contracting HIV in the USA. However, the HIV epidemic impacts some groups of MSM disproportionately. Latino MSM comprise 25.1% of new HIV infections among MSM between the ages of 13 and 29 years. The daily medication tenofovir/emtricitabine was approved by the Food and Drug Administration for pre-exposure prophylaxis (PrEP) in 2012 and has demonstrated strong efficacy in reducing HIV acquisition.Methods and analysisThrough extensive formative research, this study uses a pilot randomised controlled trial design and will examine the feasibility and acceptability of a patient navigation intervention designed to address multiple barriers to improve engagement in the PrEP continuum among 60 Latino MSM between the ages of 18 and 29 years. The patient navigation intervention will be compared with usual care plus written information to evaluate the feasibility and acceptability of the intervention and study methods and the intervention’s potential in improving PrEP continuum behaviours. The results will be reviewed for preparation for a future full-scale efficacy trial.Ethics and disseminationThis study was approved by the institutional review board at San Diego State University and is registered at ClinicalTrials.gov. The intervention development process, plan and the results of this study will be shared through peer-reviewed journal publications, conference presentations and healthcare system and community presentations.Registration detailsRegistered under the National Institutes of Health’s ClinicalTrials.gov (NCT04048382) on 7 August 2019 and approved by the San Diego State University (HS-2017–0187) institutional review board. This study began on 5 August 2019 and is estimated to continue through 31 March 2021. The clinical trial is in the pre-results stage.
Objective: We examined alcohol use and harms, and their interrelations among cisgender and transgender college students. Method: We conducted a secondary analysis using a U.S. sample of 4-year-college students (n = 242,624; M age = 20.24, SD = 1.67; 12.31% Hispanic/Latinx and 62.11% non-Hispanic/Latinx White, 3.99% Black, 11.88% Asian or Pacific Islander,0.37% American Indian, Alaskan Native or Native Hawaiian, 9.35% Multiracial/ethnic/other). These outcomes were compared between cisgender women (68.53%) and cisgender men (29.27%), transgender men (0.91%), transgender women (0.23%), and nonbinary students (1.06%): level (number of drinks) of recent alcohol use, frequency of binge drinking (≥5 drinks) in the past 2 weeks, and occurrence and count of harms while drinking in the past year. Gender differences in the association between drinking level and consequences were also examined. Results: Cisgender women were the reference group for all of the comparisons. Cisgender men reported less occurrence of regret, sex without their consent, and unprotected sex when drinking, but the greater occurrence of injury and trouble with the police. Transgender women and nonbinary individuals reported lower odds of regret and unprotected sex when drinking. Transgender men and nonbinary individuals reported increased odds of sex without their consent when drinking. All transgender subgroups reported increased odds of suicidal ideation when drinking. Finally, associations between the level of recent drinking and odds of experiencing harms differed by gender identity. Conclusions: Patterns of alcohol use, consequences, and their interrelationship differed for cisgender men, transgender women and men, and nonbinary individuals relative to cisgender women. There is a need for gender-inclusive prevention for alcohol harms among students. Public Health Significance StatementThis study identified that the risk of experiencing harms when drinking differed between cisgender, transgender, and nonbinary college students. This suggests that gender identity should be considered when making recommendations about low-risk drinking levels and when designing interventions to prevent alcohol harms for students with diverse gender identities.
Body image disturbance is a common problem reported among sexual minority men living with HIV, and is associated with poor antiretroviral therapy (ART) adherence. Recently, a novel integrated intervention (cognitive behavioral therapy for body image and self-care; CBT-BISC) was developed and pilot tested to simultaneously improve body image and ART adherence in this population. Although CBT-BISC has demonstrated preliminary efficacy in improving ART adherence, the mechanisms of change are unknown. Utilizing data from a two-armed randomized controlled trial (N = 44 sexual minority men living with HIV), comparing CBT-BISC to an enhanced treatment as usual (ETAU) condition, sequential process mediation via latent difference scores was assessed, with changes in body image disturbance entered as the mechanism between treatment condition and changes in ART adherence. Participants assigned to CBT-BISC reported statistically significant reductions in body image disturbance post-intervention, which subsequently predicted changes in ART adherence from post-intervention to long term follow-up (b = 20.01, SE = 9.11, t = 2.19, p = 0.028). One pathway in which CBT-BISC positively impacts ART adherence is through reductions in body image disturbance. Body image disturbance represents one, of likely several, mechanism that prospectively predicts ART adherence among sexual minority men living with HIV.
Sexual minority males are a group at high risk for developing skin cancer, which may be related to elevated rates of indoor tanning. Tanning dependence may be one risk factor for indoor tanning behavior, yet little research has focused on the predictors of skin cancer risk behaviors in sexual minority males. The aim of the current study was to explore the association between tanning dependence and skin cancer risk behaviors in a sample of sexual minority males. Participants were 230 sexual minority males of age 15–35 years (M = 24.66, SD = 5.44) living in San Diego County, California, United States. Participants completed measures of skin cancer risk behaviors (e.g., indoor tanning behavior and use of sunscreen), and tanning dependence was measured via the Behavioral Addiction Indoor Tanning Screener. Results demonstrated significant positive associations between tanning dependence and all measures of skin cancer risk behaviors. Elevated tanning dependence was associated with greater indoor tanning frequency (b = .75, p < .001), greater odds of having indoor tanned (odds ratio = 1.84, p = .007), greater intent to indoor tan (b = .90, p < .001), and lower sunscreen use (b = −.22, p = .002). These results highlight the role of tanning dependence in understanding why sexual minority males may engage in skin cancer risk behaviors. Skin cancer prevention efforts aimed at reducing indoor tanning in sexual minority males may benefit from adding a component designed to address tanning dependence in this population.
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